Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Article Search Process
2.2. Statistical Analysis
3. Results
3.1. Effects of Exercise Interventions on Body Weight
3.2. Effects of Exercise Interventions on BMI
3.3. Effects of Exercise Interventions on Visceral Fat
3.4. Effects of Exercise Interventions on Lean Body Mass
4. Discussion
4.1. Effects on Body Weight, BMI, Body Fat Percentage, and Waist Circumference
4.2. Effects on Lean Body Mass
4.3. Understanding of Exercise Interventions
4.4. Potential Mechanisms of Exercise Effects for Oveweright and Obese Individuals
4.5. Limitations of Our Meta-Analysis Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
References
- WHO. Obesity and Oberweight. Available online: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 29 August 2020).
- Neeland, I.J.; Ross, R.; Despres, J.P.; Matsuzawa, Y.; Yamashita, S.; Shai, I.; Seidell, J.; Magni, P.; Santos, R.D.; Arsenault, B.; et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: A position statement. Lancet Diabetes Endocrinol. 2019, 7, 715–725. [Google Scholar] [CrossRef]
- Koliaki, C.; Liatis, S.; Kokkinos, A. Obesity and cardiovascular disease: Revisiting an old relationship. Metabolism 2019, 92, 98–107. [Google Scholar] [CrossRef]
- Kuroda, M.; Sakaue, H. Adipocyte Death and Chronic Inflammation in Obesity. J. Med. Investig. 2017, 64, 193–196. [Google Scholar] [CrossRef] [Green Version]
- Guo, X.; Zhang, T.; Shi, L.; Gong, M.; Jin, J.; Zhang, Y.; Liu, R.; Chang, M.; Jin, Q.; Wang, X. The relationship between lipid phytochemicals, obesity and its related chronic diseases. Food Func. 2018, 9, 6048–6062. [Google Scholar] [CrossRef]
- Ladhani, M.; Craig, J.C.; Irving, M.; Clayton, P.A.; Wong, G. Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: A systematic review and meta-analysis. Nephrol. Dial. Transplant. 2017, 32, 439–449. [Google Scholar] [CrossRef] [Green Version]
- Swift, D.L.; McGee, J.E.; Earnest, C.P.; Carlisle, E.; Nygard, M.; Johannsen, N.M. The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Prog. Cardiovasc. Dis. 2018, 61, 206–213. [Google Scholar] [CrossRef]
- Kim, H.; Reece, J.; Kang, M. Effects of Accumulated Short Bouts of Exercise on Weight and Obesity Indices in Adults: A Meta-Analysis. Am. J. Health Promot. 2020, 34, 96–104. [Google Scholar] [CrossRef]
- Weiss, E.P.; Jordan, R.C.; Frese, E.M.; Albert, S.G.; Villareal, D.T. Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity. Med. Sci. Sports Exerc. 2017, 49, 206–217. [Google Scholar] [CrossRef]
- Westerterp, K.R. Exercise, energy expenditure and energy balance, as measured with doubly labelled water. Proc. Nutr. Soc. 2018, 77, 4–10. [Google Scholar] [CrossRef]
- Maillard, F.; Pereira, B.; Boisseau, N. Effect of High-Intensity Interval Training on Total, Abdominal and Visceral Fat Mass: A Meta-Analysis. Sports Med. 2018, 48, 269–288. [Google Scholar] [CrossRef]
- Verreijen, A.M.; Engberink, M.F.; Memelink, R.G.; van der Plas, S.E.; Visser, M.; Weijs, P.J. Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: A randomized controlled trial. Nutr. J. 2017, 16, 10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hens, W.; Taeyman, J.; Cornelis, J.; Gielen, J.; Van Gaal, L.; Vissers, D. The Effect of Lifestyle Interventions on Excess Ectopic Fat Deposition Measured by Noninvasive Techniques in Overweight and Obese Adults: A Systematic Review and Meta-Analysis. J. Phys. Act. Health 2016, 13, 671–694. [Google Scholar] [CrossRef]
- Ouwens, D.M.; Bekaert, M.; Lapauw, B.; Van Nieuwenhove, Y.; Lehr, S.; Hartwig, S.; Calders, P.; Kaufman, J.M.; Sell, H.; Eckel, J.; et al. Chemerin as biomarker for insulin sensitivity in males without typical characteristics of metabolic syndrome. Arch. Physiol. Biochem. 2012, 118, 135–138. [Google Scholar] [CrossRef] [PubMed]
- Garcia-Hermoso, A.; Ceballos-Ceballos, R.J.; Poblete-Aro, C.E.; Hackney, A.C.; Mota, J.; Ramirez-Velez, R. Exercise, adipokines and pediatric obesity: A meta-analysis of randomized controlled trials. Int. J. Obes. 2017, 41, 475–482. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gotzsche, P.C.; Ioannidis, J.P.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. J. Clin. Epidemiol. 2009, 339, b2700. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Higgins, J.P.; Altman, D.G.; Gotzsche, P.C.; Juni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.; et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011, 343, d5928. [Google Scholar] [CrossRef] [Green Version]
- Egger, M.; Davey Smith, G.; Schneider, M.; Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997, 315, 629–634. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Begg, C.B.; Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994, 50, 1088–1101. [Google Scholar] [CrossRef]
- Batrakoulis, A.; Jamurtas, A.Z.; Georgakouli, K.; Draganidis, D.; Deli, C.K.; Papanikolaou, K.; Avloniti, A.; Chatzinikolaou, A.; Leontsini, D.; Tsimeas, P.; et al. High intensity, circuit-type integrated neuromuscular training alters energy balance and reduces body mass and fat in obese women: A 10-month training-detraining randomized controlled trial. PLoS ONE 2018, 13, e0202390. [Google Scholar] [CrossRef] [Green Version]
- Besnier, F.; Lenclume, V.; Gerardin, P.; Fianu, A.; Martinez, J.; Naty, N.; Porcherat, S.; Boussaid, K.; Schneebeli, S.; Jarlet, E.; et al. Individualized Exercise Training at Maximal Fat Oxidation Combined with Fruit and Vegetable-Rich Diet in Overweight or Obese Women: The LIPOXmax-Reunion Randomized Controlled Trial. PLoS ONE 2015, 10, e0139246. [Google Scholar] [CrossRef] [Green Version]
- Blue, M.N.M.; Smith-Ryan, A.E.; Trexler, E.T.; Hirsch, K.R. The effects of high intensity interval training on muscle size and quality in overweight and obese adults. J. Sci. Med. Sport 2018, 21, 207–212. [Google Scholar] [CrossRef] [PubMed]
- Coker, R.H.; Williams, R.H.; Kortebein, P.M.; Sullivan, D.H.; Evans, W.J. Influence of exercise intensity on abdominal fat and adiponectin in elderly adults. Metab. Syndr. Relat. Disord. 2009, 7, 363–368. [Google Scholar] [CrossRef]
- Gepner, Y.; Shelef, I.; Schwarzfuchs, D.; Zelicha, H.; Tene, L.; Yaskolka Meir, A.; Tsaban, G.; Cohen, N.; Bril, N.; Rein, M.; et al. Effect of Distinct Lifestyle Interventions on Mobilization of Fat Storage Pools: CENTRAL Magnetic Resonance Imaging Randomized Controlled Trial. Circulation 2018, 137, 1143–1157. [Google Scholar] [CrossRef] [PubMed]
- Goodpaster, B.H.; Delany, J.P.; Otto, A.D.; Kuller, L.; Vockley, J.; South-Paul, J.E.; Thomas, S.B.; Brown, J.; McTigue, K.; Hames, K.C.; et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: A randomized trial. JAMA 2010, 304, 1795–1802. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hunter, G.R.; Brock, D.W.; Byrne, N.M.; Chandler-Laney, P.C.; Del Corral, P.; Gower, B.A. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity 2010, 18, 690–695. [Google Scholar] [CrossRef] [Green Version]
- Irving, B.A.; Davis, C.K.; Brock, D.W.; Weltman, J.Y.; Swift, D.; Barrett, E.J.; Gaesser, G.A.; Weltman, A. Effect of exercise training intensity on abdominal visceral fat and body composition. Med. Sci. in Sports Exerc. 2008, 40, 1863–1872. [Google Scholar] [CrossRef] [Green Version]
- Irwin, M.L.; Yasui, Y.; Ulrich, C.M.; Bowen, D.; Rudolph, R.E.; Schwartz, R.S.; Yukawa, M.; Aiello, E.; Potter, J.D.; McTiernan, A. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: A randomized controlled trial. JAMA 2003, 289, 323–330. [Google Scholar] [CrossRef]
- Johnson, N.A.; Sachinwalla, T.; Walton, D.W.; Smith, K.; Armstrong, A.; Thompson, M.W.; George, J. Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology 2009, 50, 1105–1112. [Google Scholar] [CrossRef]
- Ko, G.; Davidson, L.E.; Brennan, A.M.; Lam, M.; Ross, R. Abdominal Adiposity, Not Cardiorespiratory Fitness, Mediates the Exercise-Induced Change in Insulin Sensitivity in Older Adults. PLoS ONE 2016, 11, e0167734. [Google Scholar] [CrossRef]
- Park, S.M.; Kwak, Y.S.; Ji, J.G. The Effects of Combined Exercise on Health-Related Fitness, Endotoxin, and Immune Function of Postmenopausal Women with Abdominal Obesity. J. Immunol. Res. 2015, 830567. [Google Scholar] [CrossRef] [Green Version]
- Park, S.K.; Park, J.H.; Kwon, Y.C.; Kim, H.S.; Yoon, M.S.; Park, H.T. The effect of combined aerobic and resistance exercise training on abdominal fat in obese middle-aged women. J. Physiol. Anthropol. Appl. Hum. Sci. 2003, 22, 129–135. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Quist, J.S.; Rosenkilde, M.; Petersen, M.B.; Gram, A.S.; Sjodin, A.; Stallknecht, B. Effects of active commuting and leisure-time exercise on fat loss in women and men with overweight and obesity: A randomized controlled trial. J. Obes. 2018, 42, 469–478. [Google Scholar] [CrossRef] [PubMed]
- Schmitz, K.H.; Hannan, P.J.; Stovitz, S.D.; Bryan, C.J.; Warren, M.; Jensen, M.D. Strength training and adiposity in premenopausal women: Strong, healthy, and empowered study. Am. J. Clin. Nutr. 2007, 86, 566–572. [Google Scholar] [CrossRef] [Green Version]
- Slentz, C.A.; Aiken, L.B.; Houmard, J.A.; Bales, C.W.; Johnson, J.L.; Tanner, C.J.; Duscha, B.D.; Kraus, W.E. Inactivity, exercise, and visceral fat. STRRIDE: A randomized, controlled study of exercise intensity and amount. J. Appl. Physiol. 2005, 99, 1613–1618. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Stoner, L.; Rowlands, D.; Morrison, A.; Credeur, D.; Hamlin, M.; Gaffney, K.; Lambrick, D.; Matheson, A. Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications. Sports Med. 2016, 46, 1737–1751. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Deutz, N.E.; Bauer, J.M.; Barazzoni, R.; Biolo, G.; Boirie, Y.; Bosy-Westphal, A.; Cederholm, T.; Cruz-Jentoft, A.; Krznaric, Z.; Nair, K.S.; et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clin. Nutr. 2014, 33, 929–936. [Google Scholar] [CrossRef] [Green Version]
- Skrypnik, D.; Ratajczak, M.; Karolkiewicz, J.; Madry, E.; Pupek-Musialik, D.; Hansdorfer-Korzon, R.; Walkowiak, J.; Jakubowski, H.; Bogdanski, P. Effects of endurance and endurance-strength exercise on biochemical parameters of liver function in women with abdominal obesity. Biomed. Pharmacother. 2016, 80, 1–7. [Google Scholar] [CrossRef]
- Vissers, D.; Hens, W.; Taeymans, J.; Baeyens, J.P.; Poortmans, J.; Van Gaal, L. The effect of exercise on visceral adipose tissue in overweight adults: A systematic review and meta-analysis. PLoS ONE 2013, 8, e56415. [Google Scholar] [CrossRef] [Green Version]
- Pedersen, B.K.; Febbraio, M.A. Muscles, exercise and obesity: Skeletal muscle as a secretory organ. Nat. Rev. Endocrinol. 2012, 8, 457–465. [Google Scholar] [CrossRef]
- Zinker, B.A.; Mohr, T.; Kelly, P.; Namdaran, K.; Bracy, D.P.; Wasserman, D.H. Exercise-induced fall in insulin: Mechanism of action at the liver and effects on muscle glucose metabolism. Am. J. Physiol. Endocrinol. Metab. 1994, 266, E683–E689. [Google Scholar] [CrossRef]
- Kramer, C.K.; Zinman, B.; Retnakaran, R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann. Intern. Med. 2013, 159, 758–769. [Google Scholar] [CrossRef] [PubMed]
- Forsythe, L.K.; Wallace, J.M.; Livingstone, M.B. Obesity and inflammation: The effects of weight loss. Nutr. Res. Rev. 2008, 21, 117–133. [Google Scholar] [CrossRef] [PubMed]
First Author (Year) | Design/Numbers, Body Mass Index (BMI), and Age of Participants | Exercise Intervention | Major Outcomes |
---|---|---|---|
Batrakoulis (2018) [20] | Randomized Control Trials (RCT): control (n = 21), exercise (n = 14), vs. exercise-detraining (n = 14), Overweight or obese (25.1–34.9 kg/m2), average 36 years old | 40 weeks, 3 times/week, combined exercises including aerobic exercise, resistance exercise, and neuromotor exercise, moderate intensity | A whole-body dual-energy X-ray absorptiometry scanner |
Besnier (2015) [21] | RCT: moderate intensity (n = 46), resistance training (n = 46), 60% aerobic exercise (n = 45), vs. home exercise (n = 45), Obese older adults (27–40 kg/m2), average 20–40 years old | moderate intensity (cycle-ergometers, 60% maximal amount of oxygen uptake (VO2max), 4 days/week, 55 min) | Dual X-ray absorptiometry (DXA) |
Blue (2018) [22] | RCT: short interval training (n = 18), long interval training (n = 16), vs. control (n = 9), Obese adults (25–45 kg/m2), 18–50 years old | 8 weeks, short interval training (10 repetition of 1 min bouts, 90% peak power output), long interval training (5 repetition of 2-min bouts, 80–100% peak power output) | Muscle cross-sectional area and thigh fat thickness (ultrasound), lean mass and fat mass of legs (DXA) |
Coker (2009) [23] | RCT: moderate-intensity exercise (n = 6), high-intensity exercise (n = 6), vs. control (n = 6), Overweight or obese (26 ≤ BMI < 37 kg/m2), 65–90 years old | 12 weeks, 1000 kcal energy expend: cycle-ergometers, 50% of VO2peak, or 75% of VO2peak | Fat mass and lean tissue: X-ray, abdominal subcutaneous adipose tissues and abdominal muscle wall: computed tomography (CT) |
Gepner (2018) [24] | RCT: exercise (n = 139), vs. control (n = 139) Overweight and obese older adults (27–41 kg/m2), ≥55 years old | 18 months, 60 min, 65% MHR of aerobic training, 80% of MHR of resistance training (2 sets, leg extension, leg curl, elbow flexion, triceps extension, lateral pull-down, lower back extension, bent leg sit-ups) | Visceral adipose tissue, intrahepatic fat, pancreatic fat, intrapericardial fat, superficial subcutaneous adipose tissue, deep subcutaneous adipose tissue, renal sinus fat, and femur intermuscular adipose tissue (MRI) |
Goodpaster (2010) [25] | RCT: physical activity (n = 67), vs. control (n = 63) Obesity (>30 kg/m2), 30–55 years old | 12 months, moderate intensity physical activity, brisk walking, 60 min, 5 days/week, 10,000 steps/day | Abdominal adipose tissues and hepatic fat contents (CT) |
Hunter (2010) [26] | RCT: control (n = 26), aerobic exercise (n = 15), vs. resistance exercise (n = 18), Overweight women (27 ≤ BMI ≤ 30 kg/m2), 21–46 years old | 1 year, aerobic exercise (week 1: 20 min, 67% maximum heart rate, and then continues duration and intensity increased, week 8: 80 min, 80% of maximum heart rate), resistance exercise (squats, leg extension, leg curl, elbow flexion, triceps extension, lateral pull-down, bench press, military press, lower back extension, and bent leg sit-ups, 10 repetitions and 80% of 1RM) | Whole body lean and fat tissue (X-ray), intra-abdominal adipose tissue, deep subcutaneous adipose tissue, subcutaneous adipose tissue (CT) |
Irving (2008) [27] | RCT: control (n = 7), low-intensity exercise (n = 11), vs. high-intensity exercise (n = 9), Obese women, average 51 years old | 16 weeks, walking/running, low intensity RPE ~10–12, week 1–2 (300 kcal, 1–2 days/week), week 3–4 (350 kcal, 4 days/week), week 5–16 (400 kcal, 5–6 days/week), high-intensity RPE ~15–17 | Body fat, fat-free mass, fat mass, abdominal fat, subcutaneous fat, abdominal visceral fat, mid-thigh fat area, mid-thigh skeletal muscle: CT |
Irwin (2003) [28] | RCT: aerobic and resistance exercise (n = 87), vs. control (stretching, n = 86), Overweight or obese postmenopausal women (≥35 kg/m2), 50–75 years old | 7 weeks, aerobic exercise (60–75% MHR, 45 min), resistance exercise (10 repetitions/2 sets, leg extension, leg curls, leg press, chest press, and seated dumbbell row) | Total body fat, intra-abdominal fat, subcutaneous abdominal fat (CT) |
Johnson (2009) [29] | RCT: control (n = 8), vs. exercise (n = 12), Obesity (≥35 kg/m2) | 4 weeks, a supervised, progressive aerobic exercise, cycle ergometer, total 30–34 min (15 min sessions and 5 min rest), 3 times/week, 50% VO2peak for week 1, 60% for week 2, and 70% for weeks 3 and 4, 15 min sessions and 5 min rest | Hepatic triglyceride concentration and vastus lateralis intramyocellular triglyceride concentration (point-resolved spectroscopy), subcutaneous adipose tissues area, hepatic lipid saturation index (HMRS), visceral adipose tissue area (MRI) |
Ko (2016) [30] | RCT: combined exercise (n = 59), vs. control (n = 21), Obese old adults, 60–80 years old | 6 months, aerobic exercise (treadmill, 5 days/week, 60–70% VO2peak, 30 min, resistance exercise (3 days/week, chest press, shoulder raise, shoulder flexion, leg extension, biceps curl, abdominal crunches, modified push-ups) | Total, abdominal, abdominal subcutaneous, and visceral adipose tissue (MRI) above the L4–5 intervertebral space |
Park (2003) [31] | RCT: aerobic training group (n = 10), combined training group (n = 10), vs. control (n = 10), Overweight or obese (25–35 kg/m2), average 40 years old | Aerobic training (60–70% HRmax, 60 min, 6 days/week), combined training groups (3 days/week for resistance exercise, 3 days/week for aerobic exercise) | Abdominal visceral fat, subcutaneous fat, and visceral fat (CT) |
Park (2015) [32] | RCT: combined exercise (n = 10), vs. control (n = 10), Abdominal obese postmenopausal women (≥24 kg/m2), average 57 years old | 12 weeks, resistance exercise (70% of 1 RM, 10–12 repetitions, 3 days/week, 30 min), aerobic exercise (40–75% HRR, 40 min, 3 days/week) | Visceral fat (CT) |
Quist (2018) [33] | RCT: aerobic exercise (n = 21), leisure exercise (n = 21), vigorous exercise (n = 33), vs. control (n = 16), Obese adults (25–35 kg/m2), 20–45 years old | 6 months, bike exercise (320 kcal/day for women, 42 kcal/day for men), leisure-time exercise of moderate (50–70% VO2peak), vigorous intensity (50–70% VO2peak) | Body composition (DXA) |
Schmitz (2007) [34] | RCT: strength training (n = 71 at year 1, n = 70 at year 2). vs. control (n = 67 at year 1, n = 63 at year 3)¸Overweight or obese (25–35 kg/m2), 25–44 years old | 16 weeks, 2 days/week, 3 sets of 8–10 repetitions, quadriceps, hamstring, gluteal, pectoral, erector spinae, latissimus dorsi, rhomboid, deltoid, biceps, and triceps muscles | Body composition: DAX, abdominal fat areas (total, subcutaneous, and intraabdominal): CT at the L2–3 interspace |
Slentz (2005) [35] | RCT: high amount/vigorous intensity (n = 42), low amount/vigorous intensity (n = 46), low amount/moderate intensity (n = 40), vs. control (n = 47), Overweight and obese (25 ≤ BMI ≤ 35 kg/m2), 40–65 years old | 8 months, (1) high amount/vigorous intensity (jogging 20 miles/week), (2) low amount/vigorous intensity (jogging 12 miles/week), and (3) low amount/moderate intensity (walking 12 miles/week) | Visceral fat (CT), Subcutaneous fat, Total abdominal fat, body weight |
First Author (Year) | Random Sequence Generation | Allocation Concealment | Blinding of Participants and Personnel | Blinding of Outcome Assessment | Incomplete Outcome Data | Selective Reporting | Other Bias |
---|---|---|---|---|---|---|---|
Batrakoulis (2018) [20] | + | ? | ? | ? | + | ? | + |
Besnier (2015) [21] | + | + | ? | ? | + | ? | + |
Blue (2018) [22] | + | + | + | ? | + | + | + |
Coker (2009) [23] | + | ? | ? | ? | + | ? | + |
Gepner (2018) [24] | + | + | ? | ? | + | + | + |
Goodpaster (2010) [25] | + | ? | ? | ? | + | ? | + |
Hunter (2010) [26] | + | + | ? | + | + | ? | + |
Irving (2008) [27] | + | + | ? | ? | + | ? | + |
Irwin (2003) [28] | + | + | + | ? | + | + | + |
Johnson (2009) [29] | + | ? | ? | ? | + | ? | + |
Ko (2016) [30] | + | + | ? | ? | + | + | + |
Park (2003) [31] | + | ? | ? | ? | + | ? | + |
Park (2015) [32] | + | + | ? | ? | + | ? | + |
Quist (2018) [33] | + | + | + | ? | + | + | + |
Schmitz (2007) [34] | + | ? | ? | ? | + | ? | + |
Slentz (2005) [35] | + | + | ? | ? | + | + | + |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lee, H.S.; Lee, J. Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int. J. Environ. Res. Public Health 2021, 18, 2635. https://doi.org/10.3390/ijerph18052635
Lee HS, Lee J. Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Journal of Environmental Research and Public Health. 2021; 18(5):2635. https://doi.org/10.3390/ijerph18052635
Chicago/Turabian StyleLee, Hyun Suk, and Junga Lee. 2021. "Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" International Journal of Environmental Research and Public Health 18, no. 5: 2635. https://doi.org/10.3390/ijerph18052635