Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial

Evaluating Yoga-Based Intervention Versus the American Diabetes Association Exercise Regimen in Conjunction With Standard Care for Autonomic Neuropathy in Diabetes Mellitus: An Exploratory Clinical Trial

INTRODUCTION

Diabetic autonomic neuropathy (DAN) is a prevalent yet often overlooked complication of diabetes mellitus (DM), impacting multiple organs and substantially elevating the risk of morbidity and mortality. This study aimed to assess the effectiveness of yoga-based intervention (YBI) compared to the American Diabetes Association exercise regimen (ADA Ex. Regime) and standard care for treating autonomic neuropathy in type 2 DM.

METHODS

This open-label exploratory clinical trial featured two parallel study arms: Group A (Intervention), which received YBI alongside standard care, and Group B, which adhered to the ADA Ex. Regime in conjunction with standard care. A total of 80 participants aged 35-60, diagnosed with type 2 DM and autonomic neuropathy, were equally allocated to both groups. Data collection included nerve conduction velocity (NCV) tests, autonomic function tests (AFTs), as well as evaluations of depression and quality of life.

RESULTS

YBI demonstrated a drop in parasympathetic tone compared to the ADA Ex. Regime. Following a six-month intervention, the sympathetic activity indicator (SD2) exhibited a significantly lower value in the YBI group than in the ADA Ex. Regime group, indicating a positive effect (p < 0.05), while the ADA Ex. Regime showed more improvement in certain areas of NCV (e.g., left and right peroneal NCV, right and left peroneal F-latency), notable differences were observed in alkaline phosphatase levels, depression scores, and WHO-5 wellness, all reaching statistical significance at p < 0.05.

CONCLUSIONS

The study findings observed that a 24-week YBI significantly reduced in symptoms of diabetic neuropathy and stress. Although the ADA Ex. Regime demonstrated greater improvement in specific aspects of NCV compared to YBI, YBI outperformed the ADA Ex. Regime in enhancing WHO-5 wellness and reducing depression symptoms.

Cardio-Metabolic Disease and Polycystic Ovarian Syndrome (PCOS): A Narrative Review

Polycystic ovarian syndrome (PCOS) is considered the most common endocrine disorder affecting females in today's world. Although it has been primarily studied and discussed in terms of its reproductive symptoms such as infertility, amenorrhea or oligomenorrhea, acne, hirsutism, and mood disorders, there is yet another unexplored and under-diagnosed category in the PCOS spectrum of diseases: its cardio-metabolic consequences. PCOS patients are prone to these abnormalities from a very young age, increasing their morbidity and mortality rates compared to their regular counterparts. The usual pathogenesis of PCOS is a culmination of several genetic and environmental factors. Regarding its cardio-metabolic aspects, insulin resistance (IR) is said to be the single most important cause of a variety of metabolic risk factors, including type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), dyslipidemia, obesity, and hypertension (HTN), whereas a few other non-traditional factors such as C-reactive protein (CRP), carotid intima-media thickness (IMT), coronary artery calcification (CAC), and endothelial dysfunction are also said to be increased in PCOS patients, further increasing their risk of complications due to cardiovascular diseases (CVD). A timely diagnosis and adequate treatment of these risk factors by using lifestyle interventions, diet, and/or medications are essential to reduce the burden of PCOS in today's world. This article has highlighted an array of traditional and non-traditional cardio-metabolic consequences PCOS patients are prone to and their systematic pathogenesis. In addition, an outline of recommendations has been given in the pharmacological and non-pharmacological sections of this article, which may benefit doctors in managing this challenging condition.

Effects of Diet, Lifestyle, Chrononutrition and Alternative Dietary Interventions on Postprandial Glycemia and Insulin Resistance

As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.

Adiposity and Long-Term Adiposity Change Are Associated with Incident Diabetes: A Prospective Cohort Study in Southwest China

In order to estimate the associations of different adiposity indicators and long-term adiposity changes with risk of incident type 2 diabetes (T2DM), we conducted a 10-year prospective cohort study of 7441 adults in Guizhou, China, from 2010 to 2020. Adiposity was measured at baseline and follow-up. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs). A total of 764 new diabetes cases were identified over an average follow-up of 7.06 years. Adiposity indicators, body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), and long-term adiposity changes (both weight change and WC change) were significantly associated with an increased risk of T2DM (adjusted HRs: 1.16–1.48). Significant non-linear relationships were found between weight/WC change and incident T2DM. Compared with subjects with stable WC from baseline to follow-up visit, the subjects with WC gain ≥9 cm had a 1.61-fold greater risk of T2DM; those with WC loss had a 30% lower risk. Furthermore, the associations were stronger among participants aged 40 years or older, women, and Han Chinese. Preventing weight or WC gain and promoting maintenance of normal body weight or WC are important approaches for diabetes prevention, especially for the elderly, women, and Han Chinese.

Functional High-Intensity Interval Training Lowers Body Mass and Improves Coordination, Strength, Muscular Endurance, and Aerobic Endurance of Inmates in a German Prison

This study examined the effects of circuit-like functional high-intensity interval training (HIIT) on body composition and motor performance of inmates in an open German prison. The group of inmates (n=11) consisted of predominantly overweight males [average body-mass-index (BMI)=31.2]. They performed 6weeks of training including 3 sessions per week. The 6-week training program was framed by a pre-test and a post-test that assessed anthropometry and motor performance. On average, the inmates participated in 91.9% of all training sessions. The intervention significantly lowered body mass (p=0.007) and BMI (p=0.006). Fat mass and fat-free mass did not change significantly from pre-test to post-test. The times in 20m sprint did not change. The performance in lateral jumping from side-to-side (p=0.024), standing long jump (p=0.001), and 30–15 Intermittent Fitness Test (p<0.001) improved significantly. The greatest improvements were observed in the number of sit-ups (p<0.001) and push-ups (p<0.001). These findings suggest that (functional) HIIT is a practical and effective training method in the context of a prison.

Effects of resistance training on insulin sensitivity in the elderly: A meta-analysis of randomized controlled trials

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of resistance training in older adults on insulin sensitivity.

METHODS

Cochrane, Embase, PubMed, Web of Science and EBSCO were searched from inception to April 2021. We integrated randomized controlled trials published in English, and participants were non-athletic and aged ≥60 years. The outcome of interest was the change in insulin sensitivity, derived from the homeostatic model of insulin resistance (HOMA-IR) and hemoglobin A1c (HbA1c).

RESULTS

12 RCTs were included in this meta-analysis comparing resistance training (n = 232) with control (n = 209). Resistance exercise significantly reduced HOMA-IR level (d = -0.25, 95% CI, -0.43 to -0.06; P < 0.05) and HbA1c levels of (d = -0.51, 95% CI, -0.84 to -0.18; P < 0.05). Subgroup analysis of HOMA-IR revealed that the variables "population", "training intensity" and "period" had significant effects on HOMA-IR, with the largest effect sizes for high-intensity (d = -0.43, 95%CI, -0.85 to -0.22, P < 0.05) and long-term (more than 12 weeks) (d = -0.43, 95%CI, -0.85 to -0.22, P < 0.05) training programs in older adults without type 2 diabetes (T2D) (d = -0.23, 95%CI, -0.42 to -0.04, P < 0.05). Subgroup analysis of HbA1c suggested that resistance training programs with moderate intensity (d = -0.51, 95%CI, -0.90 to -0.12, P < 0.05) and short term (less than or equal to 12 weeks) (d = -0.49, 95%CI, -0.84 to -0.14, P < 0.05) have greater effects on HbA1c.

CONCLUSION

The findings of this meta-analysis suggest that resistance training is effective for inducing improvement in insulin sensitivity for elderly. Subgroup analysis showed that high intensity and long period of resistance exercise improve HOMA-IR in healthy old adults, and that resistance training with moderate intensity and short period improve HbA1c in T2D old people. More studies with high methodological qualities and large sample sizes need to be done to further confirm our conclusion.

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

BACKGROUND

Resistance training is the gold standard exercise mode for accrual of lean muscle mass, but the isolated effect of resistance training on body fat is unknown.

OBJECTIVES

This systematic review and meta-analysis evaluated resistance training for body composition outcomes in healthy adults. Our primary outcome was body fat percentage; secondary outcomes were body fat mass and visceral fat.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

We searched five electronic databases up to January 2021.

ELIGIBILITY CRITERIA

We included randomised trials that compared full-body resistance training for at least 4 weeks to no-exercise control in healthy adults.

ANALYSIS

We assessed study quality with the TESTEX tool and conducted a random-effects meta-analysis, with a subgroup analysis based on measurement type (scan or non-scan) and sex (male or female), and a meta-regression for volume of resistance training and training components.

RESULTS

From 11,981 records, we included 58 studies in the review, with 54 providing data for a meta-analysis. Mean study quality was 9/15 (range 6-15). Compared to the control, resistance training reduced body fat percentage by - 1.46% (95% confidence interval - 1.78 to - 1.14, p < 0.0001), body fat mass by - 0.55 kg (95% confidence interval - 0.75 to - 0.34, p < 0.0001) and visceral fat by a standardised mean difference of - 0.49 (95% confidence interval - 0.87 to - 0.11, p = 0.0114). Measurement type was a significant moderator in body fat percentage and body fat mass, but sex was not. Training volume and training components were not associated with effect size. Resistance training reduces body fat percentage, body fat mass and visceral fat in healthy adults.

STUDY REGISTRATION

osf.io/hsk32.

Differential Effects of Resistance- and Endurance-Based Exercise Programs on Muscular Fitness, Body Composition, and Cardiovascular Variables in Young Adult Women: Contextualizing the Efficacy of Self-Selected Exercise Modalities

There is an evident lack of research simultaneously investigating endurance training (ET) and resistance training (RT) with regard to their potential influence on fitness and health status in young women. This study aimed to determine the effects of RT and ET three times a week over an eight-week period on anthropometric/body composition indices, blood pressure (BP), and muscular fitness in apparently healthy young women who participated in a self-preferred program. The sample of participants comprised 57 young healthy women (23.9 ± 3.08 years, 165.5 ± 5.8 cm, 66.8 ± 7.2 kg) divided into ET (n = 18), RT (n = 19), and non-exercising (C) (n = 20) groups. The variables consisted of anthropometric/body composition indices (body mass, BMI, body fat, and lean body mass), muscular fitness variables (lower body strength, upper body strength, abdominal strength, dynamometric force, and flexibility), and cardiovascular parameters (resting heart rate and systolic and diastolic BP). A pre- and post-testing design, with factorial analysis of variance for repeated measurements (ANOVA: Group × Measurement), including a consecutive post hoc test, was applied. The ANOVA indicated a similar improvement in body composition (increase in lean body mass and decrease in body fat percentage), resting heart rate, and flexibility in both of the exercise groups, with no significant changes in the C group. RT improved the participants' strength and force capacities to a greater extent than ET. BP showed a trend of improvement in both of the training groups, but without statistically significant pre- to post-changes. Correlation analysis calculated with variables of pre- to post-differences (VDs) indicated poor associations between VDs, indicating relative independence of the obtained effects for the different variables in each training group. Although this investigation comprised apparently healthy young women, numerous positive changes indicated the efficacy of both programs in a relatively short period of time. While the participants in this study self-selected training programs, the evidenced positive effects can be at least partially related to this fact.

Exercising for Insulin Sensitivity - Is There a Mechanistic Relationship With Quantitative Changes in Skeletal Muscle Mass?

Skeletal muscle (SM) tissue has been repetitively shown to play a major role in whole-body glucose homeostasis and overall metabolic health. Hence, SM hypertrophy through resistance training (RT) has been suggested to be favorable to glucose homeostasis in different populations, from young healthy to type 2 diabetic (T2D) individuals. While RT has been shown to contribute to improved metabolic health, including insulin sensitivity surrogates, in multiple studies, a universal understanding of a mechanistic explanation is currently lacking. Furthermore, exercised-improved glucose homeostasis and quantitative changes of SM mass have been hypothesized to be concurrent but not necessarily causally associated. With a straightforward focus on exercise interventions, this narrative review aims to highlight the current level of evidence of the impact of SM hypertrophy on glucose homeostasis, as well various mechanisms that are likely to explain those effects. These mechanistic insights could provide a strengthened rationale for future research assessing alternative RT strategies to the current classical modalities, such as low-load, high repetition RT or high-volume circuit-style RT, in metabolically impaired populations.

Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Visceral adipose tissue (VAT) are deleterious fat deposits in the human body and can be effectively reduced by exercise intervention. Despite well-established exercise prescriptions are available, the effective dosage of exercise for reducing VAT requires verification.

OBJECTIVES

The aims of this systematic review and meta-analysis were to determine the most effective exercise dosage (modality, intensity, duration, and amount) for decreasing VAT.

METHODS

Nine databases (EMBASE, Medline, Cochrane Central Register of Controlled Trial, PubMed, CINAHL, Scopus, Web of Science, Airiti Library, and PerioPath) were systematically searched for randomized controlled trials that objectively assessed VAT. The arms of included studies covered with different exercise modalities and dosage. Relevant databases were searched through February 2020.

RESULTS

Of the 34 studies (n = 1962) included in systematic review, 32 (n = 1900) were pooled for pairwise or network meta-analysis. The results indicated that high-intensity interval training (SMD -0.39, 95% CI -0.60 to -0.18) and aerobic exercise (SMD -0.26, 95% CI -0.38 to -0.13) of at least moderate intensity were beneficial for reducing VAT. By contrast, resistance exercise, aerobic exercise combined with resistance exercise, and sprint interval training had no significant effects. No difference in VAT reduction was observed between exercising more or less than 150 min per week. Meta-regression revealed that the effect of VAT reduction was not significantly influenced by an increase in the duration of or amount of exercise in an exercise program. The effective dosage of exercise for reducing VAT was three times per week for 12 to 16 weeks, while duration per session for aerobic exercise was 30-60 min, and either less than 30 min or 30-60 min of high-intensity interval training accomplished sufficient energy expenditure to impact VAT.

CONCLUSIONS

These results can inform exercise prescriptions given to the general population for improving health by reducing VAT.

Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor

PURPOSE

Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored.

METHODS

A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate.

RESULTS

Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI.

CONCLUSIONS

The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.

Indices of Cardiovascular Health, Body Composition and Aerobic Endurance in Young Women; Differential Effects of Two Endurance-Based Training Modalities

Endurance training (ET) has multiple beneficial effects on cardiovascular health (CVH), but there is an evident lack of knowledge on differential effects of various types of ET on indices of CVH in women. The aim of this study was to analyse the effectiveness of two different types of ET on changes in indicators of CVH in apparently healthy adult women. The sample included 58 women (24 ± 3 years; height: 165 ± 6 cm, mass: 66.7 ± 7.2 kg, BMI: 24.3 ± 2.5 kg/m², at baseline) divided into one control non-exercising group (n = 19), and two exercising experimental groups (EE). The first EE participated in choreographed aerobic-endurance training (CAT; n = 19), while the second participated in treadmill-based endurance exercise (TEE; n = 20) during the experimental protocol (8 weeks, 24 training sessions). The testing included pre- and post-exercise protocols and measures of anthropometric/body composition indices, lipid panel, and endurance capacity. Two-way analysis of variance for repeated measurements with consecutive post hoc analysis was applied to the “group” and “measurement” variables. The main significant ANOVA effects found for measurement, and “Group x Measurement” interaction (p < 0.05) were found for all variables but body height. The EE induced positive changes in lipid panel variables, anthropometric/body-build status, and endurance capacity. However, TEE improved endurance capacity to a greater extent than CAT. The results suggest that that the optimal exercise intensity and self-chosen type of physical-activity may result in positive effects on indices of CVH, even in women of young age and good health status.

Comparison of Muscular Endurance and Hypertrophy Resistance Training on Cardiovascular Disease Risk in Sedentary Male Smokers

Background: Cardiovascular disease (CVD) exemplifies a major medical problem as it is the most considerable cause of morbidity and mortality. While sport conditioning specialists understand and differentiate the different benefits of resistance training (RT) subtypes on athletic performance, this distinction is less clear for health professionals when designing CVD risk reduction programs. Objectives: This study attempted to investigate and compare the effects of hypertrophy and muscular endurance RT on CVD risk in sedentary males. Methods: Sedentary male smokers were randomly assigned to either an eight-week hypertrophy RT group (HTG) (n = 15), muscular endurance RT groups (METG) (n = 15), or a non-exercising control group (CON) (n = 15) to assess their impact on smoking, blood pressure, cholesterol, and cardiorespiratory fitness (VO2max) variables associated with the four most prominent CVD risk factors. Data were analyzed using SPSS-25 software using a paired sample t-test and ANOVA. Results: Significant (P ≤ 0.05) improvements were found in three of the 15 measured variables in the HTG (resting mean arterial pressure (RMAP) (P = 0.024); total cholesterol (TC): HDL-C ratio (P = 0.009), and HDL-C: low-density lipoprotein cholesterol (LDL-C) ratio (P = 0.038), with a deleterious decrease in high-density lipoprotein cholesterol (HDL-C) (P = 0.027). In turn, significant improvements were found in the METG in 10 of the 15 measured variables, namely; cigarettes smoked per day (P = 0.037), resting systolic blood pressure (RSBP) (P = 0.002), resting diastolic blood pressure (RDBP) (P = 0.006), RMAP (P = 0.000), TC (P = 0.010), triglycerides (TG) (P = 0.010), LDL-C (P = 0.007), HDL-C: LDL-C (P = 0.018), non-HDL-C (n-HDL-C) (P = 0.010), and VO2max (P = 0.001), and a deleterious decrease in HDL-C (P = 0.026). Conclusions: While the oversimplification of RT design for CVD reduction has resulted in cardio-centric CVD training programs, this study demonstrates that some subtypes of RT (i.e. muscular endurance training) may prove more useful than others in reducing multiple CVD risk factors simultaneously.

Effect of exercise on myosteatosis in adults: a systematic review and meta-analysis

Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. Several studies have assessed the effects of exercise alone on the severity of myosteatosis, and some studies have reported promising results. We performed a systematic review and meta-analysis to investigate the effects of exercise interventions on myosteatosis (i.e., lipid infiltration and muscle radiation attenuation). Studies were identified through a systematic search of three databases and limited to randomized controlled trials (RCTs) focused on evaluating the effect of exercise interventions on lipid infiltration and/or muscle attenuation in adults. Thirteen studies met the inclusion criteria, and 12 were included in the meta-analysis (n = 465, 84.7% women). The volume of lipid infiltration was decreased in the exercise group compared with the control group [Hedges' g = -0.45, 95% confidence interval (CI), -0.74 to -0.16; P = 0.008, I² = 0%], and the degree of muscle radiation attenuation was increased (Hedges' g = 0.67, 95% CI, 0.22 to 1.13; P = 0.009, I² = 59.3%). Based on meta-regression analyses, there were no significant effects of mean age at baseline (lipid infiltration, β = -0.008, 95% CI, -0.035 to 0.019; P = 0.495; muscle radiation attenuation, β = -0.013, 95% CI, -0.036 to 0.011; P = 0.248) and intervention duration (lipid infiltration, β = -0.008, 95% CI, -0.028 to 0.010; P = 0.311; muscle radiation attenuation, β = -0.018, 95% CI, -0.050 to 0.014; P = 0.230) on the effect size estimates. Overall, our findings indicate that exercise can significantly improve muscle quality in populations at risk of developing obesity and sarcopenia-related disability.NEW & NOTEWORTHY Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. The volume of lipid infiltration tissue was decreased in the exercise group compared with the control group, and muscle attenuation coefficient was increased. Based on the meta-regression analyses, the mean age at baseline and intervention duration did not affect the effect size estimates for lipid infiltration tissue and muscle radiation attenuation.

Association between the Thigh Muscle and Insulin Resistance According to Body Mass Index in Middle-Aged Korean Adults

BACKGROUND

We examined the associations between thigh muscle area (TMA) and insulin resistance (IR) according to body mass index (BMI) in middle-aged Korean general population.

METHODS

TMA was measured using quantitative computed tomography and corrected by body weight (TMA/Wt) in 1,263 men, 788 premenopausal women, and 1,476 postmenopausal women all aged 30 to 64 years. The tertiles of TMA/Wt were calculated separately for men and for premenopausal and postmenopausal women. Homeostatic model assessment for insulin resistance (HOMA-IR) was performed using fasting blood glucose and insulin levels, and increased IR was defined according to sex-specific, top quartiles of HOMA-IR. Associations between the TMA/Wt tertiles and increased IR according to the BMI categories (<25 and ≥25 kg/m²) were assessed using multivariable logistic regression analysis.

RESULTS

In men with higher BMIs, but not in those with lower BMIs, the presence of an increased IR had significantly higher odds ratios in the lower TMA/Wt tertiles, even after adjustment for visceral fat area. However, in premenopausal and postmenopausal women, there was no significant inverse association between TMA/Wt tertiles and increased IR, regardless of BMI category.

CONCLUSION

Our findings suggest that the thigh muscle is inversely associated with IR in men, particularly in those with higher BMIs.

Musculoskeletal adaptations to strength training in frail elderly: a matter of quantity or quality?

BACKGROUND

The improvement in muscle strength generally exceeds the increase in muscle size following strength training in frail elderly, highlighting the complex aetiology of strength deficit in aging. The aim of this study was to investigate the effect of heavy-load strength training on a broad number of factors related to specific strength in frail elderly.

METHODS

Thirty-four frail elderly men (n = 18) and women (n = 16) aged 67 to 98 (86 ± 7 years) were randomized to either a group performing strength training twice a week for 10 weeks (ST) or a non-exercising control group (CON). Knee extensor muscle strength was tested as one-repetition maximum (1RM) and isometric maximal voluntary contraction (MVC) torque. Muscle activation was assessed by the interpolated twitch technique, and muscle density [mean Hounsfield units (HU)] and intermuscular adipose tissue (IMAT) by computed tomography scans of the quadriceps femoris. Muscle biopsies from the vastus lateralis were obtained to investigate changes in intramyocellular lipids and single-fibre specific tension.

RESULTS

In ST, knee extension 1RM and MVC improved by 17 and 7%, respectively. Muscle cross-sectional area of the quadriceps femoris increased by 7%, accompanied by a 4% increase of muscle density. No changes in IMAT, voluntary activation level, single-fibre specific tension, or lipid content were observed.

CONCLUSIONS

In contrast to several previous reports, the improvements in isometric muscle strength and muscle area were in good agreement in the present study. The training-induced increase in muscle density was not due to changes in skeletal muscle lipid content. Instead, the increase in muscle density may reflect increased packing of contractile material or simply an increased ratio of muscle tissue relative to IMAT.

Strength plus Endurance Training and Individualized Diet Reduce Fat Mass in Overweight Subjects: A Randomized Clinical Trial

Studies with overweight people are a priority in order to observe the effect of the timing of intervention on pre-obesity people. The aim was to compare different physical activity programs plus an individualized hypocaloric diet on body composition in overweight subjects. A randomized controlled clinical trial was carried out in overweight adults with no history of relevant illness. Primary outcome was total fat mass (TFM). Participants were allocated into four activity programs with equal intensity and volume of exercise for 22 weeks: strength training (S), endurance training (E), strength + endurance training (SE), and ‘adhering to physical activity recommendations’ (C). Participants followed a diet with 25% less energy (50%–55% carbohydrates, 30%–35% fat) measured by accelerometer. Variables were assessed at baseline and at the end of the intervention. Body composition was measured by dual-energy X-ray absorptiometry. One hundred nineteen from 205 subjects were randomized in the four exercise groups (S = 30/E = 30/SE = 30/C = 29) and 84 participants (36 men/48 women) ended the intervention (S = 19/E = 25/SE = 22/C = 18). At the end of the experiment, all groups except C increased their total physical activity (S = 1159 ± 1740; E = 1625 ± 1790; SE = 1699 ± 2516; C = 724 ± 1979 MET-min/week). Using an ANOVA-test, improvements were observed in body weight (S = −4.6 ± 4.5; E = −6.6 ± 4.6; SE = −8.5 ± 2.8; C = −6.1 ± 5.6 kg, p = 0.059) and TFM (S = −4.24 ± 2.02; E = −4.74 ± 2.96; SE = −6.74 ± 3.27; C = −3.94 ± 4.18%; p < 0.05). The main conclusion was that there were no adverse events. Strength and endurance training with a balanced, individualized hypocaloric diet was the most effective at reducing weight loss and fat mass in overweight subjects. Trial registration: NCT01116856.

Exercise training results in depot-specific adaptations to adipose tissue mitochondrial function

We assessed differences in mitochondrial function in gluteal (gSAT) and abdominal subcutaneous adipose tissue (aSAT) at baseline and in response to 12-weeks of exercise training; and examined depot-specific associations with body fat distribution and insulin sensitivity (SI). Obese, black South African women (n = 45) were randomized into exercise (n = 23) or control (n = 22) groups. Exercise group completed 12-weeks of aerobic and resistance training (n = 20), while the control group (n = 15) continued usual behaviours. Mitochondrial function (high-resolution respirometry and fluorometry) in gSAT and aSAT, SI (frequently sampled intravenous glucose tolerance test), body composition (dual-energy X-ray absorptiometry), and ectopic fat (MRI) were assessed pre- and post-intervention. At baseline, gSAT had higher mitochondrial respiratory capacity and hydrogen peroxide (H2O2) production than aSAT (p < 0.05). Higher gSAT respiration was associated with higher gynoid fat (p < 0.05). Higher gSAT H2O2 production and lower aSAT mitochondrial respiration were independently associated with lower SI (p < 0.05). In response to training, SI improved and gynoid fat decreased (p < 0.05), while H2O2 production reduced in both depots, and mtDNA decreased in gSAT (p < 0.05). Mitochondrial respiration increased in aSAT and correlated with a decrease in body fat and an increase in soleus and hepatic fat content (p < 0.05). This study highlights the importance of understanding the differences in mitochondrial function in multiple SAT depots when investigating the pathophysiology of insulin resistance and associated risk factors such as body fat distribution and ectopic lipid deposition. Furthermore, we highlight the benefits of exercise training in stimulating positive adaptations in mitochondrial function in gluteal and abdominal SAT depots.

Strength Training and Insulin Resistance: The Mediating Role of Body Composition

The main objective of the present study was to assess the association between participation in strength training and insulin resistance. Another goal was to assess the influence of several potential confounding variables on the strength training and insulin resistance relationship. Lastly, the influence of waist circumference, fat-free mass (kg), body fat percentage, and the fat-free mass index on the association between strength training and insulin resistance was assessed. This cross-sectional study included 6,561 randomly selected men and women in the U.S. Data were collected using the precise protocol established by NHANES. HOMA-IR was used as the outcome variable to index insulin resistance. Both time spent strength training and frequency of strength training bouts were used as exposure variables. There was not a statistically significant relationship between strength training and insulin resistance in women. However, before and after controlling for 11 potential confounding variables, men who reported no strength training had significantly higher levels of HOMA-IR compared to men who reported moderate or high levels of strength training (F = 9.87, P < 0.0001). Odds ratios were also assessed. Men reporting no strength training had 2.42 times the odds of having insulin resistance compared to men reporting moderate levels of strength training (95% CI: 1.19-4.93). Similarly, men reporting no strength training had 2.50 times the odds of having insulin resistance compared to men reporting high levels of strength training (95% CI: 1.25-5.00). In conclusion, there was a strong relationship between strength training and insulin resistance in U.S. men, but not in U.S. women. Differences in waist circumference, fat-free mass (kg), body fat percentage, and the fat-free mass index, as well as demographic and lifestyle measures, do not appear to mediate the relationship. The present study was not a clinical trial.

Comparisons of Resistance Training and "Cardio" Exercise Modalities as Countermeasures to Microgravity-Induced Physical Deconditioning: New Perspectives and Lessons Learned From Terrestrial Studies

Prolonged periods in microgravity (μG) environments result in deconditioning of numerous physiological systems, particularly muscle at molecular, single fiber, and whole muscle levels. This deconditioning leads to loss of strength and cardiorespiratory fitness. Loading muscle produces mechanical tension with resultant mechanotransduction initiating molecular signaling that stimulates adaptations in muscle. Exercise can reverse deconditioning resultant from phases of detraining, de-loading, or immobilization. On Earth, applications of loading using exercise models are common, as well as in μG settings as countermeasures to deconditioning. The primary modalities include, but are not limited to, aerobic training (or "cardio") and resistance training, and have historically been dichotomized; the former primarily thought to improve cardiorespiratory fitness, and the latter primarily improving strength and muscle size. However, recent work questions this dichotomy, suggesting adaptations to loading through exercise are affected by intensity of effort independent of modality. Furthermore, similar adaptations may occur where sufficient intensity of effort is used. Traditional countermeasures for μG-induced deconditioning have focused upon engineering-based solutions to enable application of traditional models of exercise. Yet, contemporary developments in understanding of the applications, and subsequent adaptations, to exercise induced muscular loading in terrestrial settings have advanced such in recent years that it may be appropriate to revisit the evidence to inform how exercise can used in μG. With the planned decommissioning of the International Space Station as early as 2024 and future goals of manned moon and Mars missions, efficiency of resources must be prioritized. Engineering-based solutions to apply exercise modalities inevitably present issues relating to devices mass, size, energy use, heat production, and ultimately cost. It is necessary to identify exercise countermeasures to combat deconditioning while limiting these issues. As such, this brief narrative review considers recent developments in our understanding of skeletal muscle adaptation to loading through exercise from studies conducted in terrestrial settings, and their applications in μG environments. We consider the role of intensity of effort, comparisons of exercise modalities, the need for concurrent exercise approaches, and other issues often not considered in terrestrial exercise studies but are of concern in μG environments (i.e., O2 consumption, CO2 production, and energy costs of exercise).

Physical Activity, Cardiorespiratory Fitness, and the Metabolic Syndrome

Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome.

Combined aerobic and resistance training, and incidence of diabetes: A retrospective cohort study in Japanese older women

AIMS/INTRODUCTION

To investigate the relationship between combined aerobic and resistance training, and the incidence of type 2 diabetes mellitus.

MATERIALS AND METHODS

The present study included 10,680 Japanese women. Participants enrolled between 2005 and 2010, and were followed up until 2014. The frequency of combined training was counted for the first 3 months, the 6th month and the 9th month. In 2014, women reported whether or not they had diabetes, as well as the year of developing diabetes. Hazard ratios and 95% confidence intervals (CI) for the incidence of type 2 diabetes were obtained using Cox proportional hazard models.

RESULTS

The median duration of follow up was 5 years, with 166 women developing type 2 diabetes. Using the lowest frequency of training group (1st quartile) as the reference, the hazard ratios for the second through fourth quartiles was as follows: 0.95 (95% CI 0.64-1.41), 0.73 (95% CI 0.48-1.13) and 0.69 (95% CI 0.44-1.07), respectively (P for trend = 0.116). After adjustment for age, body mass index and thigh circumference, the hazard ratios were: 0.84 (95% CI 0.56-1.26), 0.69 (95% CI 0.45-1.06) and 0.61 (95% CI 0.39-0.95), respectively (P for trend = 0.040).

CONCLUSIONS

A higher frequency of combined aerobic and resistance training is associated with a lower risk of developing type 2 diabetes in Japanese women.

Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article

Polycystic ovary syndrome (PCOS) is a heterogeneous condition which is related to an endocrine reproductive disorder of females. It affects females of 18-44 age. The persistent hormonal disbalance leads to the complexities such as numerous cysts, an irregular menstrual cycle that ultimately leads to infertility among females. Many candidate genes have been identified to be one of the causes of PCOS. Different studies have been carried out to find the genetic correlation of PCOS. It is essential to carry out such studies that identify the clear cause of PCOS and its genetic association and hormonal disbalance. This review has highlighted different genes and their correlation with PCOS that leads to hormonal disbalance. Yet not in-depth but an attempt to study the genetic predisposition of PCOS.

The Effect of Exercise on Glucoregulatory Hormones: A Countermeasure to Human Aging: Insights from a Comprehensive Review of the Literature

Hormones are secreted in a circadian rhythm, but also follow larger-scale timetables, such as monthly (hormones of the menstrual cycle), seasonal (i.e., winter, summer), and, ultimately, lifespan-related patterns. Several contexts modulate their secretion, such as genetics, lifestyle, environment, diet, and exercise. They play significant roles in human physiology, influencing growth of muscle, bone, and regulating metabolism. Exercise training alters hormone secretion, depending on the frequency, duration, intensity, and mode of training which has an impact on the magnitude of the secretion. However, there remains ambiguity over the effects of exercise training on certain hormones such as glucoregulatory hormones in aging adults. With advancing age, there are many alterations with the endocrine system, which may ultimately alter human physiology. Some recent studies have reported an anti-aging effect of exercise training on the endocrine system and especially cortisol, growth hormone and insulin. As such, this review examines the effects of endurance, interval, resistance and combined training on hormones (i.e., at rest and after) exercise in older individuals. We summarize the influence of age on glucoregulatory hormones, the influence of exercise training, and where possible, examine masters' athletes' endocrinological profile.

Lifestyle changes in women with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions.

OBJECTIVES

To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS.

SEARCH METHODS

We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, conference abstracts, relevant journals, reference lists of relevant papers and reviews, and grey literature databases, with no language restrictions applied.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS.

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials, assessed evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD).

MAIN RESULTS

We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence).

AUTHORS' CONCLUSIONS

Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.

Effect of Exercise and Pharmacological Interventions on Visceral Adiposity: A Systematic Review and Meta-analysis of Long-term Randomized Controlled Trials

OBJECTIVE

To assess the effectiveness of exercise and pharmacotherapy interventions in reducing visceral adipose tissue (VAT).

PATIENTS AND METHODS

A systematic search of Ovid MEDLINE, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, New York Academy of Science Grey Literature Report, and OpenGrey was combined with hand searches of existing literature. A total of 2515 titles and abstracts were reviewed. Only randomized controlled trials evaluating the effectiveness of monitored exercise or pharmacological interventions in reducing VAT by using computed tomography or magnetic resonance imaging during a sustained intervention period (≥6 months) were included. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed for quality and risk of bias. Separate analyses for each intervention were performed using random effect models, with pooled estimates of the change in VAT area (in centimeters squared) from baseline to follow-up reported as standardized mean difference (SMD; with 95% CI).

RESULTS

A total of 3602 participants from 17 randomized controlled trials were included in the final analysis. Both exercise and pharmacological interventions were associated with significant reductions in VAT: small reduction with pharmacological interventions (SMD, -0.27; 95% CI, -0.47 to -0.07; P=.02) and more substantial reductions with exercise interventions (SMD, -0.54; 95% CI, -0.63 to -0.46; P<.001). The mean absolute VAT reduction was greater in pharmacological trials than in exercise trials. Meta-regression exhibited a linear correlation between VAT and weight loss (R²=0.52 for exercise and R²=0.88 for pharmacological interventions), but VAT reduction relative to weight loss differed by intervention type.

CONCLUSION

Exercise interventions resulted in greater reduction in VAT relative to weight loss than did pharmacological interventions. A preferential reduction in VAT may be clinically meaningful when monitoring success of interventions because weight loss alone may underestimate benefits.

The Impact of High-Intensity Interval Training on Brain Derived Neurotrophic Factor in Brain: A Mini-Review

The brain-derived neurotrophic factor (BDNF) is a protein mainly synthetized in the neurons. Early evidence showed that BDNF participates in cognitive processes as measured at the hippocampus. This neurotrophin is as a reliable marker of brain function; moreover, recent studies have demonstrated that BDNF participates in physiological processes such as glucose homeostasis and lipid metabolism. The BDNF has been also studied using the exercise paradigm to determine its response to different exercise modalities; therefore, BDNF is considered a new member of the exercise-related molecules. The high-intensity interval training (HIIT) is an exercise protocol characterized by low work volume performed at a high intensity [i.e., ≥80% of maximal heart rate (HRmax)]. Recent evidence supports the contention that HIIT elicits higher fat oxidation in skeletal muscle than other forms of exercise. Similarly, HIIT is a good stimulus to increase maximal oxygen uptake (VO₂max). Few studies have investigated the impact of HIIT on the BDNF response. The present work summarizes the effects of acute and long-term HIIT on BDNF.

Does resistance training modulate cardiac autonomic control? A systematic review and meta-analysis

PURPOSE

To systematically evaluate the literature on the effects of resistance training (RT) on cardiac autonomic control in healthy and diseased individuals.

METHODS

Electronic databases Pubmed, PEDro, and Scopus were systematically searched from their inception up to June 2018. Randomized controlled trials, quasi-experimental trials, and cross-over controlled trials investigating the effect of RT (of at least 4 weeks duration) on cardiac autonomic control assessed either by linear or non-linear measures of heart rate variability (HRV), baroreflex sensitivity, or post-exercise heart rate recovery were included. Of the studies retrieved, 28 were included in the systematic review. Meta-analysis was performed on 21 studies of the total 28 studies.

RESULTS

Quality and characteristic assessment revealed fair quality evidence. The majority of literature on healthy humans suggested no change in cardiac autonomic control following RT. Standardized mean differences (SMD) showed a significant effect of RT on root mean square of successive differences between adjacent inter-beat (R-R) intervals (RMSSD) [SMD 0.96, 95% confidence interval (CI) 0.20-1.73; p = 0.01], ratio of low- to high-frequency power of HRV (LF/HF ratio; SMD -0.72, 95% CI -1.03 to -0.42; p < 0.00001), standard deviation of the instantaneous beat-to-beat variability (SD1; SMD 1.78, 95% CI 1.07-2.49, p < 0.00001), and sample entropy (SMD 1.17, 95% CI 0.36-1.97, p = 0.005) in diseased individuals.

CONCLUSION

This rigorous systematic analysis revealed that RT has no or minimal effects on cardiac autonomic control of healthy individuals, but RT leads to improvement in cardiac autonomic control of diseased individuals.

Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients

BACKGROUND

In cancer patients with a poor prognosis, low skeletal muscle radiographic density is associated with higher mortality. Whether this association also holds for early-stage cancer is not very clear. We aimed to study the association between skeletal muscle density and overall mortality among early-stage (stage I-III) colorectal cancer (CRC) patients. Furthermore, we investigated the association between skeletal muscle density and both CRC-specific mortality and disease-free survival in a subset of the study population.

METHODS

Skeletal muscle density was assessed in 1681 early-stage CRC patients, diagnosed between 2006 and 2015, using pre-operative computed tomography images. Adjusted Cox proportional hazard models were used to evaluate the association between muscle density and overall mortality, CRC-specific mortality and disease-free survival.

RESULTS

The median follow-up time was 48 months (range 0-119 months). Low muscle density was detected in 39% of CRC patients. Low muscle density was significantly associated with higher mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53-2.38). After stratification for comorbidities, the association was highest in patients with ≥ 2 comorbidities (HR 2.11, 95% CI 1.55-2.87). Furthermore, low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14-2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89-3.17) in a subset of the study population.

CONCLUSION

In early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival.

Effects of Consecutive Versus Non-consecutive Days of Resistance Training on Strength, Body Composition, and Red Blood Cells

Health authorities worldwide recommend 2–3 days per week of resistance training (RT) performed ∼48–72 h apart. However, the influence of recovery period between RT sessions on muscle strength, body composition, and red blood cells (RBCs) are unclear.

Aim: Examine the effects of three consecutive (C) or non-consecutive (NC) days of RT per week for 12 weeks on strength, body composition, and RBCs.

Methods: Thirty young, healthy and recreationally active males were randomly assigned to 3 C (∼24 h between sessions) or NC (∼48–72 h between sessions) days of RT per week for 12 weeks. Both groups performed three sets of 10 repetitions at 10-repetition maximum (RM) of leg press, latissimus pulldown, leg curl, shoulder press, and leg extension for each session. Ten RM and body composition were assessed pre- and post-RT. RBC parameters were measured on the first session before RT, and 0 and 24 h post-3rd session in untrained (week 1) and trained (week 12) states.

Results: No training × group interaction was found for all strength and body composition parameters (p = 0.075–0.974). Training increased strength for all exercises, bone mineral density, and total body mass via increased lean and bone mass (p < 0.001). There was no interaction (p = 0.076–0.994) and RT induced temporal changes in all RBC parameters (p < 0.001–0.003) except RBC corrected for plasma volume changes (time × training interaction; p = 0.001). Training increased hematocrit and lowered mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration (p = 0.001–0.041) but did not alter uncorrected RBC, hemoglobin, mean corpuscular volume and RBC distribution width (p = 0.178–0.797).

Conclusion: Both C and NC RT induced similar improvements in strength and body composition, and changes in RBC parameters.

Concurrent Aerobic and Resistance Training Has Anti-Inflammatory Effects and Increases Both Plasma and Leukocyte Levels of IGF-1 in Late Middle-Aged Type 2 Diabetic Patients

Type 2 diabetes (T2D) is an age-related chronic disease associated with metabolic dysregulation, chronic inflammation, and activation of peripheral blood mononuclear cells (PBMC). The aim of this study was to assess the effects of a concurrent exercise training program on inflammatory status and metabolic parameters of T2D patients. Sixteen male patients (age range 55–70) were randomly assigned to an intervention group (n = 8), which underwent a concurrent aerobic and resistance training program (3 times a week; 16 weeks), or to a control group, which followed physicians' usual diabetes care advices. Training intervention significantly improved patients' body composition, blood pressure, total cholesterol, and overall fitness level. After training, plasma levels of adipokines leptin (−33.9%) and RBP4 (−21.3%), and proinflammatory markers IL-6 (−25.3%), TNF-α (−19.8%) and MCP-1 (−15.3%) decreased, whereas anabolic hormone IGF-1 level increased (+16.4%). All improvements were significantly greater than those of control patients. Plasma proteomic profile of exercised patients showed a reduction of immunoglobulin K light chain and fibrinogen as well. Training also induced a modulation of IL-6, IGF-1, and IGFBP-3 mRNAs in the PBMCs. These findings confirm that concurrent aerobic and resistance training improves T2D-related metabolic abnormalities and has the potential to reduce the deleterious health effects of diabetes-related inflammation.

Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis

INTRODUCTION

Type 2 diabetes (T2D) in elderly patients is associated with accelerated loss of skeletal muscle mass and strength. However, there are few meta-analysis reviews which investigate the effects of resistance training (RT) on glycemic control and skeletal muscle in the patients.

METHODS

Three electronic databases were searched (from the earliest date available to November 2016). Studies were included according to the inclusion criteria: T2D patients at least 60 years old, fasting plasma glucose of at least 7.0, and at least 8 weeks of RT.

RESULTS

Fifteen cohorts of eight studies (360 patients, average age 66 years) met the inclusion criteria. RT groups lowered glycosylated hemoglobin (HbA1c) (mean ES = -0.37, 95% CI = -0.55 to -0.20, P < 0.01) but did not result in a significant effect on lean body mass (LBM) (mean ES = 0.08, 95% CI = -0.15 to 0.30, P = 0.50). Homogeneity was shown between studies regarding HbA1c and LBM (Q = 15.70, df = 9, P = 0.07 and Q = 0.12, df = 4, P = 0.998, respectively). High-intensity subgroups showed a slight tendency to improve (rather than duration, frequency, and weekly volume) and to decrease HbA1c levels more than low-intensity subgroups (P = 0.37). RT increased muscular strength (mean ES = 1.05, 95% CI = 0.26-1.84, P = 0.01). No training components explained the heterogeneity between studies with changes in muscle strength.

CONCLUSION

RT improves glycemic control and muscle strength in elderly patients with T2D. RT with high intensity can be a strategy to treat patients with T2D and sarcopenia associated with aging.

Functional High-Intensity Circuit Training Improves Body Composition, Peak Oxygen Uptake, Strength, and Alters Certain Dimensions of Quality of Life in Overweight Women

The effects of circuit-like functional high-intensity training (Circuit_HIIT) alone or in combination with high-volume low-intensity exercise (Circuit_combined) on selected cardio-respiratory and metabolic parameters, body composition, functional strength and the quality of life of overweight women were compared. In this single-center, two-armed randomized, controlled study, overweight women performed 9-weeks (3 sessions·wk⁻¹) of either Circuit_HIIT (n = 11), or Circuit_combined (n = 8). Peak oxygen uptake and perception of physical pain were increased to a greater extent (p < 0.05) by Circuit_HIIT, whereas Circuit_combined improved perception of general health more (p < 0.05). Both interventions lowered body mass, body-mass-index, waist-to-hip ratio, fat mass, and enhanced fat-free mass; decreased ratings of perceived exertion during submaximal treadmill running; improved the numbers of push-ups, burpees, one-legged squats, and 30-s skipping performed, as well as the height of counter-movement jumps; and improved physical and social functioning, role of physical limitations, vitality, role of emotional limitations, and mental health to a similar extent (all p < 0.05). Either forms of these multi-stimulating, circuit-like, multiple-joint training can be employed to improve body composition, selected variables of functional strength, and certain dimensions of quality of life in overweight women. However, Circuit_HIIT improves peak oxygen uptake to a greater extent, but with more perception of pain, whereas Circuit_combined results in better perception of general health.

The effect of resistance exercise on fitness, blood pressure, and blood lipid of hypertensive middle-aged men

The purpose of this study is to investigate the effect of resistance exercise on fitness, blood pressure, and blood lipid of hypertensive middle-aged men. To achieve the goal of the study, a total of 23 subjects were selected. Among them, 14 subjects who exercised regularly were selected as the exercise group, while the remaining 9 subjects were selected as the control group. In terms of data processing, the IBM SPSS Statistics ver. 21.0 software was used to calculate the mean and standard deviation. Regarding the verification of difference on the change of means between the groups, analysis of covariance was used for statistical process. As a result, significant differences were found in cardiovascular endurance, muscle endurance, flexibility, and triglyceride. These results indicate that the resistance exercise only had slight effect on hypertensive middle-aged men.

Increased Adipose and Muscle Insulin Sensitivity Without Changes in Serum Adiponectin in Young Female Collegiate Athletes

BACKGROUND

Effects of endurance training on adipose insulin sensitivity in association with body composition, circulating adipokines, and markers of inflammation have been studied less in young Asian subjects.

METHODS

Adipose insulin sensitivity/resistance was compared between 170 female Japanese collegiate athletes and 311 nonathletes (18-24 years), who underwent measurements of serum adipokines, markers of insulin sensitivity, inflammation, and dual-energy X-ray absorptiometry. Two separate subsamples of two groups of women underwent either a 75-gram oral glucose tolerance test or a standardized meal test, but not both.

RESULTS

As compared with nonathletes, athletes, characterized by higher skeletal muscle mass and lower percentage of body fat (both P < 0.001), had lower adipose insulin resistance (IR) (a product of fasting insulin and nonesterified fatty acid (NEFA) and lower leptin/adiponectin ratio (both P < 0.001). Although athletes had lower postmeal/postglucose insulinemia (P = 0.009 and 0.01, respectively), the two groups did not differ in postmeal percentage NEFA suppression and postmeal/postglucose glycemia, suggesting increased insulin sensitivity in adipose tissue and skeletal muscle, respectively. Serum leptin (P < 0.001) and tumor necrosis factor-α (P = 0.01) were lower in athletes, whereas adiponectin and homeostasis model assessment IR did not differ.

CONCLUSIONS

Endurance training was associated with increased insulin sensitivity in adipose tissue as well as skeletal muscle without changes in circulating adiponectin even in young, normal-weight Japanese women.

Role of therapeutic fasting in women's health: An overview

Fasting is a therapeutic tool practiced since millennia by different cultures and medical systems heterogeneously. PubMed and Google Scholar search engines were searched using the keywords "fasting," "intermittent fasting," "calorie restriction," "women's health," "women's disorders," "fasting and aging," and "fasting and health." All the animal and human studies which address women's health and disorders were included in the review. Fasting has shown to improve the reproductive and mental health. It also prevents as well as ameliorates cancers and musculoskeletal disorders which are common in middle-aged and elderly women. The present studies available have limitations such as majority of the studies are preclinical studies and human studies are with lesser sample size. Future studies should address this gap by designing medically supervised fasting techniques to extract better evidence. Nevertheless, fasting can be prescribed as a safe medical intervention as well as a lifestyle regimen which can improve women's health in many folds.

Meta-Analyses of the Effects of Habitual Running on Indices of Health in Physically Inactive Adults

Background

In order to implement running to promote physical activity, it is essential to quantify the extent to which running improves health.

Objective

The aim was to summarise the literature on the effects of endurance running on biomedical indices of health in physically inactive adults.

Data Sources

Electronic searches were conducted in October 2014 on PubMed, Embase, CINAHL, SPORTDiscus, PEDro, the Cochrane Library and LILACS, with no limits of date and language of publication.

Study Selection

Randomised controlled trials (with a minimum of 8 weeks of running training) that included physically inactive but healthy adults (18–65 years) were selected. The studies needed to compare intervention (i.e. endurance running) and control (i.e. no intervention) groups.

Study Appraisal and Synthesis Methods

Two authors evaluated study eligibility, extracted data, and assessed risk of bias; a third author resolved any uncertainties. Random-effects meta-analyses were performed to summarise the estimates for length of training and sex. A dose-response analysis was performed with random-effects meta-regression in order to investigate the relationship between running characteristics and effect sizes.

Results

After screening 22,380 records, 49 articles were included, of which 35 were used to combine data on ten biomedical indices of health. On average the running programs were composed of 3.7 ± 0.9 sessions/week, 2.3 ± 1.0 h/week, 14.4 ± 5.4 km/week, at 60–90 % of the maximum heart rate, and lasted 21.5 ± 16.8 weeks. After 1 year of training, running was effective in reducing body mass by 3.3 kg [95 % confidence interval (CI) 4.1–2.5], body fat by 2.7 % (95 % CI 5.1–0.2), resting heart rate by 6.7 min⁻¹ (95 % CI 10.3–3.0) and triglycerides by 16.9 mg dl⁻¹ (95 % CI 28.1–5.6). Also, running significantly increased maximal oxygen uptake (VO_2max) by 7.1 ml min⁻¹ kg⁻¹ (95 % CI 5.0–9.1) and high-density lipoprotein (HDL) cholesterol by 3.3 mg dl⁻¹ (95 % CI 1.2–5.4). No significant effect was found for lean body mass, body mass index, total cholesterol and low-density lipoprotein cholesterol after 1 year of training. In the dose-response analysis, larger effect sizes were found for longer length of training.

Limitations

It was only possible to combine the data of ten out the 161 outcome measures identified. Lack of information on training characteristics precluded a multivariate model in the dose-response analysis.

Conclusions

Endurance running was effective in providing substantial beneficial effects on body mass, body fat, resting heart rate, VO_2max, triglycerides and HDL cholesterol in physically inactive adults. The longer the length of training, the larger the achieved health benefits. Clinicians and health authorities can use this information to advise individuals to run, and to support policies towards investing in running programs.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-015-0359-y) contains supplementary material, which is available to authorized users.

Plyometric exercise combined with high-intensity interval training improves metabolic abnormalities in young obese females more so than interval training alone

The aim of this study was to compare the effects of 12 weeks of high-intensity interval training (HIIT) with the effects of 12 weeks of plyometric exercise combined with HIIT (P+HIIT) on anthropometric, biochemical, and physical fitness data in young obese females. Sixty-eight participants (age, 16.6 ± 1.3 y; body mass, 82.8 ± 5.0 kg; body fat, 39.4% ± 3.3%; body mass index z score, 2.9 ± 0.4) were assigned to 1 of 3 groups: HIIT (2 blocks per session of 6–8 bouts of 30-s runs at 100% velocity at peak oxygen uptake, with 30-s active recovery between bouts at 50%velocity at peak oxygen uptake (n = 23)); P+HIIT (2 blocks per session of 3 different 15-s plyometric exercises with 15-s passive recoveries, totaling 2 min for each plyometric exercise + the same HIIT program (n = 26)); or control (no exercise (n = 19)). Anthropometric (body mass, body mass index z score, body fat, lean body mass, and waist circumference), biochemical (plasma glucose, insulin, leptin and adiponectin concentrations, leptin/adiponectin ratio, and homeostasis model assessment of insulin resistance (HOMA-IR)), physical fitness (peak oxygen uptake, velocity at peak oxygen uptake, squat jump, and countermovement jump performances), and energy intake data were collected. Both training programs improved the anthropometric, biochemical, and physical fitness variables. However, the P+HIIT program induced greater improvements than did the HIIT program in lean body mass (+3.0% ± 1.7%), plasma glucose and leptin concentrations (–11.0% ± 4.7% and –23.8% ± 5.8%, respectively), plasma leptin/adiponectin ratio (–40.9% ± 10.9%), HOMA-IR (–37.3% ± 6.2%), and squat jump performance (22.2% ± 7.5%). Taken together, these findings suggest that adding plyometric exercises to a HIIT program may be more beneficial than HIIT alone in obese female adolescents.

Vascular repair strategies in type 2 diabetes: novel insights

Impaired functions of vascular cells are responsible for the majority of complications in patients with type 2 diabetes (T2D). Recently a better understanding of mechanisms contributing to development of vascular dysfunction and the role of systemic inflammatory activation and functional alterations of several secretory organs, of which adipose tissue has more recently been investigated, has been achieved. Notably, the progression of vascular disease within the context of T2D appears to be driven by a multitude of incremental signaling shifts. Hence, successful therapies need to target several mechanisms in parallel, and over a long time period. This review will summarize the latest molecular strategies and translational developments of cardiovascular therapy in patients with T2D.

Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Guidelines recommend exercise for cardiovascular health, although evidence from trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent. We performed a meta-analysis of randomized controlled trials to quantify the impact of exercise on cardiorespiratory fitness and a variety of conventional and novel cardiometabolic biomarkers in adults without cardiovascular disease.

METHODS AND RESULTS

Two researchers selected 160 randomized controlled trials (7487 participants) based on literature searches of Medline, Embase, and Cochrane Central (January 1965 to March 2014). Data were extracted using a standardized protocol. A random-effects meta-analysis and systematic review was conducted to evaluate the effects of exercise interventions on cardiorespiratory fitness and circulating biomarkers. Exercise significantly raised absolute and relative cardiorespiratory fitness. Lipid profiles were improved in exercise groups, with lower levels of triglycerides and higher levels of high-density lipoprotein cholesterol and apolipoprotein A1. Lower levels of fasting insulin, homeostatic model assessment-insulin resistance, and glycosylated hemoglobin A1c were found in exercise groups. Compared with controls, exercise groups had higher levels of interleukin-18 and lower levels of leptin, fibrinogen, and angiotensin II. In addition, we found that the exercise effects were modified by age, sex, and health status such that people aged <50 years, men, and people with type 2 diabetes, hypertension, dyslipidemia, or metabolic syndrome appeared to benefit more.

CONCLUSIONS

This meta-analysis showed that exercise significantly improved cardiorespiratory fitness and some cardiometabolic biomarkers. The effects of exercise were modified by age, sex, and health status. Findings from this study have significant implications for future design of targeted lifestyle interventions.

Strength training and risk of type 2 diabetes in a Japanese working population: A cohort study

AIMS/INTRODUCTION

Muscle strength training has been suggested to improve glucose metabolism; however, epidemiological evidence regarding strength training's effects on diabetes risk is scarce. We prospectively examined the association between strength training and the risk of type 2 diabetes in Japanese men and women.

MATERIALS AND METHODS

The sample included health checkups on 26,630 Japanese male and female workers aged 30-64 years without diabetes at baseline. Weekly time spent on strength training was elicited using a self-reported questionnaire. Type 2 diabetes was diagnosed based on hemoglobin A1c, fasting glucose, random plasma glucose and self-report in an annual health checkup. Hazard ratio (HR) and its 95% confidence interval (CI) for incident diabetes was estimated using a Cox proportional hazards model.

RESULTS

During a mean follow up of 5.2 years with 139,748 person-years, 1,770 individuals developed diabetes. Age- and sex-adjusted HR for diabetes was 0.58 (95% CI 0.42-0.79) in those who engaged in strength training compared with those who engaged in no strength training. After further adjusting for potential confounders, the corresponding HR was 0.66 (95% CI 0.48-0.90). Additional adjustment for body mass index did not materially change the result; the HR was 0.70 (95% CI 0.51-0.96). The association was more pronounced in individuals aged 50 years or older than those aged <50 years, although the difference in the association by age was not significant.

CONCLUSIONS

These results suggest that engagement in strength training could help to reduce the risk of type 2 diabetes in a Japanese working population.

Alterations of plasma nitric oxide, vascular endothelial growth factor, and soluble form of its receptor (sFlt-1) after resistance exercise: An experimental study

BACKGROUND

This study was aimed to investigate the alterations of some plasma angiogenic factors after resistance exercise in male rats.

MATERIALS AND METHODS

TWENTY MALE RATS WERE DIVIDED INTO TWO GROUPS: Sedentary and trained (n = 10 each). The animals in the trained group undertook one training session per day, 3 days/week. After 4 weeks; plasma nitric oxide (NO), vascular endothelial growth factor (VEGF), and soluble form of VEGF receptor-1 (sFlt-1) concentrations were measured.

RESULTS

Plasma NO concentration was not different between groups (P > 0.05). Plasma VEGF concentration was also not different between sedentary and trained groups (142.73 ± 3.74 and 144.5 ± 5.1 pg/mL, respectively; P > 0.05). Resistance training did not significantly change plasma sFlt-1 concentration (P > 0.05). VEGF/sFlt-1 ratio did not alter after exercise.

CONCLUSION

Resistance training does not alter plasma angiogenic factors (NO, VEGF, and sFlt-1), at least in normal rats. More studies are needed to show the effect of resistance training on angiogenesis process.

Measurement of skeletal muscle radiation attenuation and basis of its biological variation

Skeletal muscle contains intramyocellular lipid droplets within the cytoplasm of myocytes as well as intermuscular adipocytes. These depots exhibit physiological and pathological variation which has been revealed with the advent of diagnostic imaging approaches: magnetic resonance (MR) imaging, MR spectroscopy and computed tomography (CT). CT uses computer-processed X-rays and is now being applied in muscle physiology research. The purpose of this review is to present CT methodologies and summarize factors that influence muscle radiation attenuation, a parameter which is inversely related to muscle fat content. Pre-defined radiation attenuation ranges are used to demarcate intermuscular adipose tissue [from −190 to −30 Hounsfield units (HU)] and muscle (−29 HU to +150 HU). Within the latter range, the mean muscle radiation attenuation [muscle (radio) density] is reported. Inconsistent criteria for the upper and lower HU cut-offs used to characterize muscle attenuation limit comparisons between investigations. This area of research would benefit from standardized criteria for reporting muscle attenuation. Available evidence suggests that muscle attenuation is plastic with physiological variation induced by the process of ageing, as well as by aerobic training, which probably reflects accumulation of lipids to fuel aerobic work. Pathological variation in muscle attenuation reflects excess fat deposition in the tissue and is observed in people with obesity, diabetes type II, myositis, osteoarthritis, spinal stenosis and cancer. A poor prognosis and different types of morbidity are predicted by the presence of reduced mean muscle attenuation values in patients with these conditions; however, the biological features of muscle with these characteristics require further investigation.

Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.

Insulin Sensitivity Following Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults

OBJECTIVE

Although exercise can improve insulin sensitivity, no adequate synthesis exists of exercise intervention studies with regard to their effect on insulin sensitivity. This comprehensive meta-analysis synthesized the insulin sensitivity outcomes of supervised exercise interventions.

METHOD

Extensive literature searching located published and unpublished intervention studies that measured insulin sensitivity outcomes. Eligible studies tested supervised exercise interventions among healthy adults. Primary study characteristics and results were coded. Random-effects meta-analyses of standardized mean differences included moderator analyses.

RESULTS

Data were synthesized across 2509 subjects (115 samples, 78 reports). The overall mean effect size for 2-group postintervention comparisons was 0.38 (95% confidence interval [CI] = 0.25-0.51, I (2) = 0%) and for 2-group pre-post comparisons was 0.43 (95% CI = 0.30-0.56, I (2) = 52%; higher mean insulin sensitivity for treatment than control subjects). The postintervention mean of 0.38 is consistent with treatment subjects ending studies with a mean fasting insulin of 6.8 mU/L if control participants' mean fasting insulin were 7.9 mU/L. Exploratory moderator analyses did not document different insulin sensitivity effect sizes across intervention characteristics or sample attributes.

CONCLUSION

This study documented that exercise is a valuable primary care and community health strategy for healthy adults to improve insulin sensitivity and lower the risk for diabetes conferred by insulin resistance.

The resist diabetes trial: Rationale, design, and methods of a hybrid efficacy/effectiveness intervention trial for resistance training maintenance to improve glucose homeostasis in older prediabetic adults

Advancing age is associated with reduced levels of physical activity, increased body weight and fat, decreased lean body mass, and a high prevalence of type 2 diabetes (T2D). Resistance training (RT) increases muscle strength and lean body mass, and reduces risk of T2D among older adults. The Resist Diabetes trial will determine if a social cognitive theory (SCT)-based intervention improves RT maintenance in older, prediabetic adults, using a hybrid efficacy/effectiveness approach. Sedentary, overweight/obese (BMI: 25-39.9 kg/m(2)) adults aged 50-69 (N = 170) with prediabetes (impaired fasting glucose and/or impaired glucose tolerance) completed a supervised 3-month RT (2×/wk) initiation phase and were then randomly assigned (N = 159; 94% retention) to one of two 6-month maintenance conditions: SCT or standard care. The SCT intervention consisted of faded contacts compared to standard care. Participants continue RT at an approved, self-selected community facility during maintenance. A subsequent 6-month period involves no contact for both conditions. Assessments occur at baseline and months 3 (post-initiation), 9 (post-intervention), and 15 (six months after no contact). Primary outcomes are prediabetes indices (i.e., impaired fasting and 2-hour glucose concentration) and strength. Secondary measures include insulin sensitivity, beta-cell responsiveness, and disposition index (oral glucose and C-peptide minimal model); adherence; body composition; and SCT measures. Resist Diabetes is the first trial to examine the effectiveness of a high fidelity SCT-based intervention for maintaining RT in older adults with prediabetes to improve glucose homeostasis. Successful application of SCT constructs for RT maintenance may support translation of our RT program for diabetes prevention into community settings.

Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial

It is unclear whether regular exercise alone (no caloric restriction) is a useful strategy to reduce adiposity and obesity-related metabolic risk factors in obese girls. We examined the effects of aerobic (AE) vs. resistance exercise (RE) alone on visceral adipose tissue (VAT), intrahepatic lipid, and insulin sensitivity in obese girls. Forty-four obese adolescent girls (BMI ≥95th percentile, 12-18 yr) with abdominal obesity (waist circumference 106.5 ± 11.1 cm) were randomized to 3 mo of 180 min/wk AE (n = 16) or RE (n = 16) or a nonexercising control group (n = 12). Total fat and VAT were assessed by MRI and intrahepatic lipid by proton magnetic resonance spectroscopy. Intermuscular AT (IMAT) was measured by CT. Insulin sensitivity was evaluated by a 3-h hyperinsulinemic (80 mU·m(2)·min(-1)) euglycemic clamp. Compared with controls (0.13 ± 1.10 kg), body weight did not change (P > 0.1) in the AE (-1.31 ± 1.43 kg) and RE (-0.31 ± 1.38 kg) groups. Despite the absence of weight loss, total body fat (%) and IMAT decreased (P < 0.05) in both exercise groups compared with control. Compared with control, significant (P < 0.05) reductions in VAT (Δ-15.68 ± 7.64 cm(2)) and intrahepatic lipid (Δ-1.70 ± 0.74%) and improvement in insulin sensitivity (Δ0.92 ± 0.27 mg·kg(-1)·min(-1) per μU/ml) were observed in the AE group but not the RE group. Improvements in insulin sensitivity in the AE group were associated with the reductions in total AT mass (r = -0.65, P = 0.02). In obese adolescent girls, AE but not RE is effective in reducing liver fat and visceral adiposity and improving insulin sensitivity independent of weight loss or calorie restriction.