The authors have declared that no competing interests exist.
Conceived and designed the experiments: LS SD BS GH. Performed the experiments: LS SD BS GH. Analyzed the data: LS SD BS GH. Contributed reagents/materials/analysis tools: LS SD BS GH. Wrote the paper: LS SD BS GH.
The aim of this systematic review of randomized controlled trials was to compare the effects of aerobic training (AET), resistance training (RT), and combined aerobic and resistance training (CT) on anthropometric parameters, blood lipids, and cardiorespiratory fitness in overweight and obese subjects.
Electronic searches for randomized controlled trials were performed in MEDLINE, EMBASE and the Cochrane Trial Register. Inclusion criteria were: Body Mass Index: ≥25 kg/m2, 19+ years of age, supervised exercise training, and a minimum intervention period of 8 weeks. Anthropometric outcomes, blood lipids, and cardiorespiratory fitness parameters were included. Pooled effects were calculated by inverse-variance random effect pairwise meta-analyses and Bayesian random effects network meta-analyses.
15 trials enrolling 741 participants were included in the meta-analysis. Compared to RT, AET resulted in a significantly more pronounced reduction of body weight [mean differences (MD): -1.15 kg, p = 0.04], waist circumference [MD: -1.10 cm, p = 0.004], and fat mass [MD: -1.15 kg, p = 0.001] respectively. RT was more effective than AET in improving lean body mass [MD: 1.26 kg, p<0.00001]. When comparing CT with RT, MD in change of body weight [MD: -2.03 kg, p<0.0001], waist circumference [MD: -1.57 cm, p = 0.0002], and fat mass [MD: -1.88 kg, p<0.00001] were all in favor of CT. Results from the network meta-analyses confirmed these findings.
Evidence from both pairwise and network meta-analyses suggests that CT is the most efficacious means to reduce anthropometric outcomes and should be recommended in the prevention and treatment of overweight, and obesity whenever possible.
Recent data provided by the World Health Organization illustrates that the global prevalence of overweight and obesity has more than doubled since 1980. In 2008, more than 1.4 billion adults aged 20 and older were overweight with over 500 million of them being obese
Several meta-analyses investigated the independent effects of aerobic exercise training (AET) on anthropometric and cardio-metabolic risk factors, providing evidence for reductions in body mass index (BMI), body weight (BW), waist circumference (WC), visceral adipose tissue, and increasing high-density lipoprotein cholesterol (HDL-C) and maximum oxygen uptake (VO2max)
The above mentioned meta-analyses were performed in order to compare one or more of the training modalities with the data from a sedentary control group. To date, no systematic review has pooled the effects of different training modalities on anthropometrical and cardiovascular risk factors. Therefore, the aim of the present study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of AET, RT, and CT on anthropometric outcomes, blood lipids, and cardiorespiratory fitness in overweight and obese subjects.
The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (crd.york.ac.uk/prospero/index.asp Identifier: CRD42013003905).
Queries of literature were performed using the electronic databases MEDLINE (between 1966 and December 2012), EMBASE (between 1980 and December 2012), and the Cochrane Trial Register (until December 2012) restricted to randomized controlled trials and quasi-randomized controlled trials, but no restrictions to calendar date. The following search terms were used: (
Studies were included in the meta-analysis if they met all of the following criteria:
All abstracts and full text were assessed for eligibility independently by two authors.
Full copies of studies were independently assessed by two authors for methodological quality using the risk of bias assessment tool by the Cochrane Collaboration
Across trials (n = 15), information is either from trials at a low risk of bias (green), or from trials at unclear risk of bias (yellow), or from trials at high risk of bias (red).
The following data were extracted from each study: the first author's last name, publication year, study duration, participant's sex and age, BMI, sample size, treatment effects, intervention type, dose, intensity and frequency, post mean values or differences in mean of two time point values with corresponding standard deviation. For each outcome measure of interest, pairwise and network random-effects meta-analyses were performed in order to determine the pooled relative effect of each intervention relative to every other, in terms of mean differences (MDs) between the post-intervention (or change from baseline differences in means) values of the different interventions. Combining both the post-intervention values and difference in means in one meta-analysis is a legitimate method described by the Cochrane Collaboration
Pooled effect sizes from the network meta-analyses are presented as posterior medians and 95% credible intervals (CrI) (i.e. Bayesian equivalent of confidence intervals) in the appropriate units. Separate pairwise meta-analyses were first used to compare all interventions. Network meta-analysis was then used to synthesize all the available evidence
Minimally informative normal priors were used for all treatment effect parameters and a Uniform (0,150) prior was used for the between-study standard deviation (heterogeneity) parameter. Sensitivity to this prior was assessed, but there was no meaningful change in relative effects or overall conclusions.
Three MCMC chains were used to assess convergence using Brooks-Gelman-Rubin plots and by inspection of the trace plots
The potential for inconsistency was assessed by inspection of the available evidence. In case of possible inconsistency, Bayesian p-values for the difference between direct and indirect evidence were calculated, and direct and indirect estimates were compared
Our search strategy and exclusion criteria resulted in a total of 15 trials (17 reports) extracted from 4358 articles that met the objectives and were included in the qualitative and quantitative analysis_ENREF_17_ENREF_17_ENREF_17_ENREF_17_ENREF_17_ENREF_17
Reference | Sample size, | Mean age (yrs) | Duration (months) | Study design | Exercise prescription | Outcomes (*significant changes between groups) p<0.05 |
Mean baseline BMI (kg/m2) | Female (%) | |||||
Male (%) | ||||||
Ahmadizad et al. 2007 |
16 | 40.9 | 3 | RT vs. | RT: 11 Ex, 50–60% 1RM, dose: 12 S/MG/W; | RT: ↑ VO2 max |
28.1 | 0% | AET | AET: 75–85% MHR, 60–90 min/wk; | AET: ↑ VO2 max | ||
100% | ||||||
Ballor et al. 1996 |
18 | 61 | 3 | RT vs. | RT: 7 Ex, 50–80% 1 RM, 8 R, 9 S/MG/W; | RT: ↑ LBM |
>32 | 55% | AET | AET: 50% VO2 max, 60–180 min/wk; | AET: ↓ BW, FM; ↑ VO2 max | ||
45% | ||||||
Banz et al. 2001 |
19 | 47.5 | 2.5 | RT vs. | RT: 8 Ex, 10 R, dose: 9 S/MG/W; | RT: ↓ WHR; |
33 | 0% | AET | AET: 60–85% MHR, 120 min/wk; | AET: ↓ WHR; ↑ HDL-C | ||
100% | ||||||
Bateman et al. 2011 |
196 | 49.5 | 4 | RT vs. | RT: 8 Ex, 8–12 R, dose: 9 S/MG/W; | RT: ↑ BW, LBM; ↑ VO2 max |
30.5 | 48% | AET vs. | AET: 65–80% VO2 max; 130 min/wk; | AET: ↓ BW, WC, FM, TG; ↑ VO2 max | ||
52% | CT | CT: RT: 8 Ex, 8–12 R, dose: 9 S/MG/W; RT: 65–80% VO2 max; 130 min/wk; | CT: ↓ BW, WC, FM, TG; ↑ LBM, VO2 max | |||
Davidson et al. 2009 |
108 | 67.7 | 6 | RT vs. | RT: 9 Ex, dose: 3 S/MG/W; | RT: ↓ WCa |
30 | 57% | AET vs. | AET: 60–75% VO2 max, 150 min/wk; | AET: ↓BWa,b, WCa,b, FMa,b; ↑ VO2 maxa,b | ||
43% | CT | CT: RT: 9 Ex, 3 S/MG/W, AET: 60–75% VO2 max, 150 min/wk; | CT: ↓BWa,b, WCa, FMa,b; ↑ VO2 maxa,b *compared with controla, RTb, | |||
Donges et al. 2010 |
76 | n.d | 2.5 | RT vs. | RT: 6 Ex, 75% 1RM, dose: 3 S/MG/W; | RT: ↓ WC ↑ BW, LBM |
27.8 | 58% | AET | AET: 75% MHR, 150 min/wk; | AET: ↓BW, WC, FM; ↑ LBM | ||
42% | ||||||
Fenkci et al. 2006 |
40 | 42.85 | 4 | RT vs. | RT: 6 Ex, 75–80% 1 RM, 10 R, dose: 9 S/MG/W; | RT: ↓ BW, FM; ↑ LBMAET: ↓ BW, FM |
35 | 100% | AET | AET: 50–85% HRR; 45–225 min/wk; | AET: ↓ BW, FM | ||
0% | ||||||
Fisher et al. 2011 |
97 | 30.5 | until BMI <25 kg/m | RT + CR vs. | RT: 10 Ex, 80% 1 RM, 10 R, dose: 6 S/MG/W; | RT: ↓ BW, WC, TC, TG |
28 | 100% | AET + CR | AET: 65–80% MHR,150 min/wk; | AET: ↓ BW, WC, TC, TG | ||
0% | ||||||
Janssen et al. 2002 |
25 | 36.15 | 4 | RT + CR vs. | RT: 7 Ex, 8–12 R, dose: 3 S/MG/W; | RT: ↓ BW, WHR, WC, TC, LDL-C, HDL-C |
33.8 | 100% | AET +CR | AET: 50–85% of MHR, max. 300 min/wk; | AET: ↓ BW, WHR, WC, TC | ||
0% | ||||||
Martins et al. 2010 |
32 | 73.2 | 4 | RT vs. | RT: 8 Ex, 8–15 RM, dose: 3–9 S/MG/W; | RT:/ |
30.8 | 63% | AET | AET: 40–85% HRR, 120 min/wk; | AET: ↓ BW, WC, LDL-C | ||
37% | ||||||
Potteiger et al. 2012 |
22 | 36.4 | 6 | RT vs. | RT: high: 100% 5–7 RM, moderate: 80% 8–10 RM, dose: increase from 3 to max 16 S/MG/W; | RT: ↓ HDL-C, WC, FM; ↑ LBMAET: ↓ BW, WC, TG |
31.2 | 0% | AET | AET: 65–80%VO2max; 135–180 min/wk; | AET: ↓ BW, WC, TG | ||
100% | ||||||
Rice et al. 1999 |
20 | 43.6 | 4 | RT +CR vs. | RT: 7 Ex; 8–12 R, dose: 3 S/MG/W; | RT: ↓ BW, WHR, WC |
33.05 | 0% | AET +CR | AET: 50–85% of MHR, max 300 min/wk; | AET: ↓ BW, WHR, WC | ||
100% | ||||||
Ross et al. 1994 |
24 | 36.1 | 4 | RT +CR vs. | RT: 8 Ex, 70–80% 1RM, dose: 3 S/MG/W; | RT: ↓ BW, WC |
33.1 | 100% | AET +CR | AET: 50–85% MHR, 45–180 min/wk; | AET: ↓ BW, WC | ||
0% | ||||||
Stensvold et al. 2010 |
32 | 51.23 | 3 | RT vs. | RT: 15–20 R, dose: 6–9 S/MG/W; | RT: ↓ WC, FM |
31.26 | 40% | AET vs. | AET: interval training (90–95% VO2 max), 130 min/wk; | AET: ↓ WC, FM | ||
60% | CT | CT: AET (2x wk), RT (1x wk); | CT: ↓ WC; ↑ LBM | |||
Wallace et al. 1997 |
16 | 41.2 | 3.5 | AET vs. | AET: 60–70% HRR, 180 min/wk; | AET: ↑ VO2 max, |
94 kg | 0% | CT | CT: RT: 8 Ex, 75% 1RM, 8–12 R, dose: 12 S/MG/W; AET: 60–70% HRR, 180 min/wk; | CT: ↓ FM, TG; ↑ HDL-C, VO2 max | ||
100% |
2 max, maximal oxygen uptake; WC, waist circumference; WHR, waist to hip ratio; ↑, higher/more; ↓, lower/less. AET, aerobic endurance training; BW, body weight; CR, caloric restriction; CT, combined training (RT and AET); Ex, exercises; FM, fat mass; HDL-C, high-density lipoprotein cholesterol; HRR, heart rate reserve; LBM, lean body mass; LDL-C, low-density lipoprotein cholesterol; MHR, maximum heart rate; n.d, no data; R, Repetition; RT, resistance training; S/MG/W, sets for each muscle group per week; TC, total cholesterol; TG, triacylglycerols; VO
The pooled estimate of effect size for the effects of RT vs. AET, CT vs. AET, and CT vs. RT on anthropometric and cardiovascular risk factor outcomes are summarized in
Outcomes | No. of Studies | Sample Size | MD | 95% CI | p-values | Inconsistency I2 | Egger test |
AET vs. RT | |||||||
BW (kg) | 14 | 560 | −1.15 | [−2.23, −0.07] | 0.04 | 34% | 0.032 |
WC (cm) | 10 | 410 | −1.10 | [−1.85, −0.36] | 0.004 | 0% | 0.742 |
WHR | 8 | 232 | −0.01 | [−0.02, 0.01] | 0.48 | 82% | 0.156 |
FM (kg) | 8 | 415 | −1.14 | [−1.83, −0.45] | 0.001 | 3% | 0.277 |
LBM (kg) | 7 | 335 | −1.26 | [−1.81, −0.71] | <0.00001 | 0% | 0.883 |
TC (mg/dl) | 7 | 230 | −2.40 | [−10.29, 5.50] | 0.55 | 0% | 0.270 |
LDL-C (mg/dl) | 6 | 208 | −3.69 | [−14.91, 7.52] | 0.52 | 46% | 0.841 |
HDL-C (mg/dl) | 8 | 291 | 1.49 | [−0.18, 3.16] | 0.08 | 0% | 0.203 |
TG (mg/dl) | 7 | 272 | −7.63 | [−22.61, 7.34] | 0.32 | 0% | 0.481 |
VO2max (ml/kg/min) | 7 | 260 | 2.53 | [1.62, 3.44] | <0.00001 | 0% | 0.362 |
CT vs. AET | |||||||
BW (kg) | 4 | 184 | 0.34 | [−0.39, 1.08] | 0.36 | 0% | 0.141 |
WC (cm) | 3 | 168 | −0.14 | [−1.03, 0.76] | 0.77 | 0% | 0.688 |
FM (kg) | 4 | 184 | −0.56 | [−1.34, 0.22] | 0.16 | 0% | 0.234 |
LBM (kg) | 3 | 112 | 0.90 | [0.31, 1.48] | 0.003 | 0% | 0.600 |
HDL-C (mg/dl) | 3 | 92 | 0.76 | [−1.30, 2.81] | 0.47 | 0% | 0.079 |
TG (mg/dl) | 3 | 92 | 0.19 | [−19.47, 19.86] | 0.98 | 0% | 0.297 |
VO2max (ml/kg/min) | 4 | 172 | −0.04 | [−1.47, 1.39] | 0.96 | 25% | 0.024 |
CT vs. RT | |||||||
BW (kg) | 3 | 173 | −2.03 | [−2.94, −1.12] | <0.0001 | 19% | 0.400 |
WC (cm) | 3 | 173 | −1.57 | [−2.38, −0.75] | 0.0002 | 0% | 0.295 |
FM (kg) | 3 | 173 | −1.88 | [−2.67, −1.08] | <0.00001 | 9% | 0.297 |
VO2max (ml/kg/min) | 3 | 162 | 2.79 | [1.78, 3.79] | <0.00001 | 0% | 0.102 |
2 max, maximal oxygen uptake; WC, waist circumference; WHR, waist to hip ratio. BW, body weight; CRP; FM, fat mass; HDL-C, high density lipoprotein cholesterol; LBM, lean body mass; LDL-C, low density lipoprotein cholesterol; TC, total cholesterol; TG, triacyglycerols; VO
The reduction of BW [MD: -1.15 kg (95% CI −2.23 to −0.07), p = 0.04] (I2 = 34%) (Figure S1 in
CT significantly increased LBM [MD: 0.90 kg (95% CI 0.31 to 1.48), p = 0.003] (I2 = 0%) (Figure S5 in
CT protocols were associated with a significantly more substantial reduction in BW [MD: -2.03 kg (95% CI −2.94 to −1.12), p<0.0001] (I2 = 19%) (Figure S6 in
VO2max as an indicator of cardiorespiratory fitness was significantly more improved following AET [MD: 2.53 ml/kg/min (95% CI 1.62 to 3.44), p<0.00001] (I2 = 0%) (Figure S9 in
The pooled estimates of effect size for the comparison of AET vs. RT vs. CT using both direct and indirect evidence on anthropometric and cardiovascular risk factor outcomes are summarized in
BW (kg) | WC (cm) | WHR | FM (kg) | LBM (kg) | |
AET versus | |||||
RT | −1.34 [−2.28, 0.094] | −1.3[−2.45, 0.058] | −0.006 [−0.022, 0.011] | −1.00[−1.90, 0.34] | −1.30 [−3.24, 0.74] |
CT versus | |||||
AET | −0.22 [−2.21, 1.11] | −0.22[−2.09, 1.29] | −0.049 [−0.10, 0.009] | −0.72[−2.20, 0.469] | 0.75 [−2.99, 2.77] |
CT versus | |||||
RT | −1.59 [−3.17, 0.058] | −1.54 [−3.32, 0.015] | −0.056 [−0.11, 0.006] | −1.73[−2.92, −0.30] | −0.53 [−4.36, 1.59] |
I2 | 0.817 [0.04, 2.44] | 0.72 [0.038, 2.66] | 0.016 [0.0082, 0.04] | 0.49 [0.025, 2.26] | 0.86 [0.041, 4.55] |
TC (mg/dl) | HDL-C (mg/dl) | TG (mg/dl) | VO2 max (ml/kg/min) | ||
AET versus | |||||
RT | −3.82 [−15.49, 6.66] | 1.44 [−0.60, 3.38] | −10.8 [−30.22, 8.12] | 2.67 [1.47, 3.97] | |
CT versus | |||||
AET | 10.72[−15.38, 36.84] | 0.86 [−1.64, 3.62] | 0.22 [−24.22, 28.98] | −0.019 [−1.74, 1.28] | |
CT versus | |||||
RT | 6.88 [−20.43, 33.24] | 2.30 [−0.54, 5.29] | −10.56 [−37.51, 20.39] | 2.66 [1.00, 3.99] | |
I2 | 5.87 [0.299, 23.88] | 0.78 [0.046, 3.26] | 9.79 [0.38, 36.97] | 0.519 [0.023, 2.24] |
% credible intervals); I2: estimated between study heterogeneity standard deviation (95% credible intervals); Relative intervention effectiveness is expressed as posterior medians (95
AET, aerobic exercise training; BW, body weight; CT, combined training; FM, fat mass; HDL-C, high density lipoprotein cholesterol; LBM, lean body mass; RT, resistance training; TC, total cholesterol; TG, triacyglycerols; VO2 max, maximal oxygen uptake; WC, waist circumference; WHR, waist to hip ratio;
Rank | Probabilities | ||||
median | 95% CrI | best | 2nd best | worst | |
AET | 2 | 35.9% | 61.4% | 2.7% | |
RT | 3 | 0.6% | 4.7% | 94.7% | |
CT | 1 | 63.5% | 34% | 2.5% | |
AET | 2 | 35.8% | 62.3% | 1.9% | |
RT | 3 | 0.4% | 3.8% | 95.7% | |
CT | 1 | 63.7% | 33.9% | 2.4% | |
AET | 2 | 3.5% | 77.2% | 19.2% | |
RT | 3 | 1.8% | 20.7% | 77.5% | |
CT | 1 | 94.7% | 2.1% | 3.2% | |
AET | 2 | 8.7% | 86% | 5.2% | |
RT | 3 | 0.7% | 5.5% | 93.8% | |
CT | 1 | 90.5% | 8.5% | 1% | |
AET | 3 | 4.3% | 20% | 75.6% | |
RT | 1 | 74.3% | 22.5% | 3.2% | |
CT | 2 | 21.3% | 57.4% | 21.2% | |
AET | 1 | 64% | 30.5% | 5.5% | |
RT | 2 | 18.1% | 56.2% | 25.7% | |
CT | 3 | 17.9% | 13.3% | 68.8% | |
AET | 2 | 22.6% | 70.8% | 6.6% | |
RT | 3 | 1.9% | 9.1% | 89% | |
CT | 1 | 75.5% | 20.1% | 4.4% | |
AET | 2 | 45.9% | 46.6% | 7.4% | |
RT | 3 | 6.4% | 21.2% | 72.4% | |
CT | 2 | 47.6% | 32.2% | 20.2% | |
AET | 1 | 51.1% | 48.9% | 0% | |
RT | 3 | 0% | 0.5% | 99.5% | |
CT | 2 | 48.9% | 50.6% | 0.5% |
AET, aerobic exercise training; BW, body weight; CrI, credible intervals; CT, combined training; FM, fat mass; HDL-C, high density lipoprotein cholesterol; LBM, lean body mass; RT, resistance training; TC, total cholesterol; TG, triacyglycerols; VO2 max, maximal oxygen uptake; WC, waist circumference; WHR, waist to hip ratio;
Both AET and CT were more effective in reducing body weight compared to RT (Figure S11 in
Due to the structure of the evidence, inconsistency between direct and indirect evidence was only possible for the BW outcome. No evidence of inconsistency was found with Bayesian p-values for the difference between direct and indirect evidence all greater than 0.90.
Sensitivity analysis were performed for obesity, age (≥50 years vs. <50 years) and gender. The primary analysis was confirmed when including only obese subjects. Inclusion of older people (≥50 years) resulted in slightly more pronounced effects compared to younger (<50 years), while no gender specific differences were observed (data not shown). Furthermore, a meta-analysis of change scores was performed for those trials reporting the corresponding data (10 of 15, see Table S1 in
Three studies were excluded, since study participants were not assigned to intervention groups via randomization
The Begg's and Egger's linear regression tests provided evidence for a potential publication bias for BW (p = 0.032) following comparison of AET vs. RT, and for VO2 max following comparison of CT vs. AET (p = 0.024). Funnel plots were generated for outcome measures provided by at least 10 different trials (see Figures S15-S16 in
To our knowledge, this is the first systematic review investigating the pooled effects of different exercise interventions on anthropometric outcomes, blood lipids and cardiorespiratory fitness. The main findings of this meta-analysis suggest that in subjects with a BMI ≥25 kg/m2, AET is more efficient in reducing BW, WC and FM as well as in increasing VO2max uptake when compared to RT, respectively. However, RT turned out to be more suitable when it comes to an improvement of lean body mass. Furthermore, the present results provide evidence that a combined intervention seems to be the most promising tool for management of overweight and obesity. CT was more powerful in reducing anthropometric risk factors like BW, WC or FM when compared to RT, and more effective in raising LBM when compared to AET. Pooled direct and indirect evidence on these three exercise interventions showed that CT was the most efficacious to reduce anthropometric outcomes such BW, WC and FM (with the respective ranking probabilities, following Bayesian network meta-analysis: 63%, 63% and 90%).
Since waist circumference correlates with abdominal fat mass and is considered to be an independent predictor of CDV, it can be used as a surrogate marker of abdominal fat mass
Regarding lean body mass, the results of the present meta-analyses show that both RT and CT are more effective in raising LBM when compared to AET, respectively. An increase in LBM contributes to the maintenance or may even reflect an increase in resting metabolic rate
Results suggest that exercise interventions containing aerobic sessions (whether isolated or as part of a combination training) improve cardiorespiratory fitness when compared to RT as a single training modality. A gain in cardiorespiratory fitness is known to be associated with reduced cardiovascular mortality and cancer incidence in men and women
The present systematic review has several strengths and weaknesses. The meta-analysis were conducted following a stringent protocol, i.e. in all trials, participants were randomly assigned to the intervention groups, and only supervised training protocols were included. Randomized controlled trials are considered to be the gold standard for evaluating the effects of an intervention and are subject to fewer biases as compared to observational studies. The network meta-analysis included all individuals for each outcome. Moreover the present meta-analysis had a substantial sample size (range: 323 to 664) volunteers, thus providing the power to detect statistically significant mean differences as well as to assess publication bias. Network meta-analysis methods were used to obtain coherent estimates of all treatments relative to each other, using all available evidence and adequately accounting for evidence from 3-arm trials (i.e. avoiding the repeated use of data from such trials in different comparisons). This is of particular importance in this application where there were several trials simultaneously comparing all the interventions. Overall, the estimated between-studies heterogeneity parameters were small for all networks, and there was no evidence of inconsistency, which further strengthens the conclusions. Trial characteristics suggest the consistency/similarity assumption is satisfied, which is confirmed by the statistical analysis.
Limitations of the present review include the limited number of studies and the heterogeneity of the study designs. The trials covered in the meta-analyses showed variations in population characteristics (e.g. overweight, obese, age, number and ratio of male and female participants).
A considerable confounder could be the volume of exercise (min/week) prescribed. Two studies reported exercise intensity in the CT group to be twice as high as compared to their respective RT and/or AET counterparts
In conclusion, the present systematic review and meta-analysis focused on RCTs mutually comparing AET, RT, and CT. Anthropometrical as well as cardiorespiratory fitness parameters turned out to be significantly more improved following AET or CT protocols as compared to their respective RT counterparts. With respect to the limitations of the present systematic review, a conservative interpretation of the data is required. The primary objective in obesity management is the reduction of body fat. According to the results of the pairwise meta-analysis, reduction of fat mass was significantly more pronounced following AET, and CT as compared to RT. However, addition of RT to AET strategies may prevent loss of LBM, which is a common problem in the course of weight loss in obesity management programs. Evidence from the network meta-analysis suggests that CT is the most efficacious exercise modality in the prevention and treatment of overweight, and obesity and should therefore recommended whenever possible.
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