Effect of Exercise on Total and Intra-abdominal Body Fat in Postmenopausal Women: A Randomized Controlled Trial
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CONTEXT: The increasing prevalence of obesity is a major public health concern. Physical activity may promote weight and body fat loss. OBJECTIVE: To examine the effects of exercise on total and intra-abdominal body fat overall and by level of exercise. DESIGN: Randomized controlled trial conducted from 1997 to 2001. SETTING AND PARTICIPANTS: A total of 173 sedentary, overweight (body mass index > or =24.0 and >33% body fat), postmenopausal women aged 50 to 75 years who were living in the Seattle, Wash, area. INTERVENTION: Participants were randomly assigned to an intervention consisting of exercise facility and home-based moderate-intensity exercise (n = 87) or a stretching control group (n = 86). MAIN OUTCOME MEASURE: Changes in body weight and waist and hip circumferences at 3 and 12 months; total body, intra-abdominal, and subcutaneous abdominal fat at 12 months. RESULTS: Twelve-month data were available for 168 women. Women in the exercise group participated in moderate-intensity sports/recreational activity for a mean (SD) of 3.5 (1.2) d/wk for 176 (91) min/wk. Walking was the most frequently reported activity. Exercisers showed statistically significant differences from controls in baseline to 12-month changes in body weight (-1.4 kg; 95% confidence interval [CI], -2.5 to -0.3 kg), total body fat (-1.0%; 95% CI, -1.6% to -0.4%), intra-abdominal fat (-8.6 g/cm2; 95% CI, -17.8 to 0.9 g/cm2), and subcutaneous abdominal fat (-28.8 g/cm2); 95% CI, -47.5 to -10.0 g/cm2). A significant dose response for greater body fat loss was observed with increasing duration of exercise. CONCLUSIONS: Regular exercise such as brisk walking results in reduced body weight and body fat among overweight and obese postmenopausal women.
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In sedentary, overweight, postmenopausal women, a 12-month moderate-intensity exercise intervention produced a greater percentage loss in visceral adipose tissue than in body weight, and visceral adipose tissue loss was exercise dose-dependent.
“Likewise, a greater percentage loss in VAT percentage than in body weight occurred after 12 months in a moderate-intensity exercise intervention study of sedentary, overweight, postmenopausal women. VAT loss was exercise dose-dependent (253).”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [253]
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Thorogood, A., Mottillo, S., Shimony, A., Filion, K. B., Joseph, L., Genest, J., Pilote, L., Poirier, P., Schiffrin, E. L., & Eisenberg, M. J. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.02.037 · Cited by 255 · see citing works
Effect of Exercise on Blood Pressure in Older Persons
Stewart, K. J., Bacher, A. C., Turner, K. L., Fleg, J. L., Hees, P. S., Shapiro, E. P., Tayback, M., & Ouyang, P. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.7.756 · Cited by 253 · see citing works
Reduced physical activity and risk of chronic disease: the biology behind the consequences
Booth, F. W., Laye, M. J., Lees, S. J., Rector, R. S., & Thyfault, J. P. (2007) · European Journal of Applied Physiology · doi:10.1007/s00421-007-0606-5 · Cited by 236 · see citing works
“In other randomized controlled clinical trials using imaging techniques to measure changes in visceral fat with exercise (Kay and Fiatarone Singh 2006), the fall in visceral fat ranged anywhere from a 6 to 49% reduction in exercise studies ranging from 8 to 52 weeks in length (Boudou et al. 2003; Irwin et al. 2003; Mo…”
BackgroundSlentz, C. A., Bateman, L. A., Willis, L. H., Shields, A. T., Tanner, C. J., Piner, L. W., Hawk, V. H., Muehlbauer, M. J., Samsa, G. P., Nelson, R. C., et al. (2011) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00291.2011 · Cited by 235 · see citing works
“It is also known that aerobic exercise training can significantly reduce visceral fat (5, 11, 20, 21, 27) and consistently improves insulin sensitivity (28).”
BackgroundA 3-year longitudinal study on body composition changes in the elderly: Role of physical exercise
Raguso, C. A., Kyle, U. G., Kossovsky, M. P., Roynette, C. E., Paoloni‐Giacobino, A., Hans, D. B., Genton, L., & Pichard, C. (2005) · Clinical Nutrition · doi:10.1016/j.clnu.2005.10.013 · Cited by 232 · see citing works
Neilson, H. K., Friedenreich, C. M., Brockton, N. T., & Millikan, R. C. (2009) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-08-0756 · Cited by 232 · see citing works
“candidate biomarkers exist (9-14), the plausibility of our chosen biomarkers has been discussed in recent literature (9, 13, 15) and their responses to exercise have been tested (16-20) or are currently under investigation (9) in various exercise intervention trials for postmenopausal breast cancer prevention.”
BackgroundKuna, S. T., Reboussin, D. M., Borradaile, K. E., Sanders, M. H., Millman, R. P., Zammit, G., Newman, A. B., Wadden, T. A., Jakicic, J. M., Wing, R. R., et al. (2013) · Sleep · doi:10.5665/sleep.2618 · Cited by 231 · see citing works
Friedenreich, C. M., Woolcott, C. G., McTiernan, A., Ballard-Barbash, R. R., Brant, R., Stanczyk, F. Z., Terry, T., Boyd, N. F., Yaffe, M. J., Irwin, M. L., et al. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.24.9557 · Cited by 227 · see citing works
Self-citationBody composition and cardiometabolic health across the menopause transition
Marlatt, K. L., Pitynski, D., Gavin, K. M., Moreau, K. L., Melanson, E. L., Santoro, N. F., & Kohrt, W. M. (2021) · Obesity · doi:10.1002/oby.23289 · Cited by 246 · see citing works
Exercise Effect on Weight and Body Fat in Men and Women
McTiernan, A., Sorensen, B. E., Irwin, M. L., Morgan, A., Yasui, Y., Rudolph, R. E., Surawicz, C. M., Lampe, J. W., Lampe, P. D., Ayub, K., et al. (2007) · Obesity · doi:10.1038/oby.2007.178 · Cited by 221 · see citing works
“Few trials have tested exercise effect on intraabdominal fat (27,30,31,36).”
BackgroundSelf-citationAshcraft, K. A., Peace, R. M., Betof, A. S., Dewhirst, M. W., & Jones, L. W. (2016) · Cancer Research · doi:10.1158/0008-5472.can-16-0887 · Cited by 217 · see citing works
“In general, exercise was associated with modest changes in markers of adiposity and select circulating factors (6, 12, 13).”
Donnelly, J. E., Honas, J. J., SMITH, B. K., Mayo, M. S., Gibson, C., Sullivan, D. K., Lee, J., Herrmann, S. D., Lambourne, K., & Washburn, R. A. (2013) · Obesity · doi:10.1002/oby.20145 · Cited by 210 · see citing works
Lopez, P., Taaffe, D. R., Galvão, D. A., Newton, R. U., Nonemacher, E. R., Wendt, V. M., Bassanesi, R. N., Turella, D. J. P., & Rech, A. (2022) · Obesity Reviews · doi:10.1111/obr.13428 · Cited by 210 · see citing works
“Heterogeneity ranged from I(2) = 0% to 8% after removing outliers.(33,54,66,73,77,84,85,95,98,102,105,109,115,121,122,131) No evidence of publication bias was identified in body fat percentage or whole-body fat mass (τ = 1.”
BackgroundExercise, Abdominal Obesity, Skeletal Muscle, and Metabolic Risk: Evidence for a Dose Response
Slentz, C. A., Houmard, J. A., & Kraus, W. E. (2009) · Obesity · doi:10.1038/oby.2009.385 · Cited by 202 · see citing works
“(43) studied the effects of a 12-month exercise program in overweight postmenopausal women.”
BackgroundBatrakoulis, A., Jamurtas, A. Z., Metsios, G. S., Perivoliotis, K., Liguori, G., Feito, Y., Riebe, D., Thompson, W. R., Angelopoulos, T. J., Krustrup, P., et al. (2022) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.121.008243 · Cited by 207 · see citing works
Zhang, H., Tong, T. K., Qiu, W., Zhang, X., Zhou, S., Liu, Y., & He, Y. (2017) · Journal of Diabetes Research · doi:10.1155/2017/5071740 · Cited by 208 · see citing works
Obesity in Older Adults: A Systematic Review of the Evidence for Diagnosis and Treatment
McTigue, K. M., Hess, R., & Ziouras, J. (2006) · Obesity · doi:10.1038/oby.2006.171 · Cited by 195 · see citing works
“Intensity was high in seven trials (87,89,91,93,95,96,98), moderate to high in one trial (90), moderate in one trial (99), moderate to low in one trial (94), and unreported in one trial (92).”
BackgroundNicklas, B. J., Wang, X., You, T., Lyles, M. F., Demons, J. L., Easter, L. H., Berry, M. J., Lenchik, L., & Carr, J. J. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26938 · Cited by 191 · see citing works
Human Plasma Ghrelin Levels Increase during a One-Year Exercise Program
Foster‐Schubert, K. E., McTiernan, A., Frayo, R. S., Schwartz, R. S., Rajan, K. B., Yasui, Y., Tworoger, S. S., & Cummings, D. E. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2081 · Cited by 192 · see citing works
Self-citationO'Donoghue, G., Blake, C., Cunningham, C., Lennon, O., & Perrotta, C. (2021) · Obesity Reviews · doi:10.1111/obr.13137 · Cited by 190 · see citing works
Exercise Improves Body Fat, Lean Mass, and Bone Mass in Breast Cancer Survivors
Irwin, M. L., Alvarez-Reeves, M., Cadmus, L. A., Mierzejewski, E., Mayne, S. T., Yu, H., Chung, G. G., Jones, B., Knobf, M. T., & DiPietro, L. (2009) · Obesity · doi:10.1038/oby.2009.18 · Cited by 188 · see citing works
Self-citationEkkekakis, P., Vazou, S., Bixby, W. R., & Georgiadis, E. M. (2016) · Obesity Reviews · doi:10.1111/obr.12369 · Cited by 188 · see citing works
“(70) observed a dropout of only 3% over a 12-month period among postmenopausal, overweight and low-active”
BackgroundFrank, L. L., Sorensen, B. E., Yasui, Y., Tworoger, S. S., Schwartz, R. S., Ulrich, C. M., Irwin, M. L., Rudolph, R. E., Rajan, K. B., Stanczyk, F. Z., et al. (2005) · Obesity Research · doi:10.1038/oby.2005.66 · Cited by 187 · see citing works
Self-citationLeiter, L. A., FITCHETT, D. H., Gilbert, R. E., Gupta, M., Mancini, G. B. J., McFarlane, P. A., Ross, R., Teoh, H., Verma, S., Anand, S. S., et al. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.12.054 · Cited by 184 · see citing works
Ennour-Idrissi, K., Maunsell, E., & Diorio, C. (2015) · Breast Cancer Research · doi:10.1186/s13058-015-0647-3 · Cited by 193 · see citing works
“Ten studies were conducted on premenopausal eumenorrheic women [22–32], one study on perimenopausal women [33], 13 studies on postmenopausal women [21, 34–53], and 12 studies on women with polycystic ovary syndrome (PCOS) [54–67].”
Backgroundvan Baak, M. A., Pramono, A., Battista, F., Beaulieu, K., Blundell, J. E., Busetto, L., Carraça, E. V., Dicker, D., Encantado, J., Ermolao, A., et al. (2021) · Obesity Reviews · doi:10.1111/obr.13239 · Cited by 169 · see citing works
“The characteristics of the seven included RCTs 13,33,53,70,71,81 with 251 participants are presented in Table S13.”
InfluentialRolland, Y., Lauwers‐Cancès, V., Pahor, M., Fillaux, J., Grandjean, H., & Vellas, B. J. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/79.4.552 · Cited by 168 · see citing works
“Numerous studies have suggested the same cross-sectional association between a high level of physical activity and BMI or body fat (27–29), but information concerning large elderly populations in epidemiologic studies is scarce (26, 27, 30, 31).”
BackgroundTworoger, S. S., Yasui, Y., Vitiello, M. V., Schwartz, R. S., Ulrich, C. M., Aiello, E. J., Irwin, M. L., Bowen, D. J., Potter, J. D., & McTiernan, A. (2003) · SLEEP · doi:10.1093/sleep/26.7.830 · Cited by 166 · see citing works
Self-citationTéhard, B., Friedenreich, C. M., Oppert, J., & Clavel‐Chapelon, F. (2006) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-05-0603 · Cited by 165 · see citing works
Khaw, K.-T., Jakes, R., Bingham, S., Welch, A., Luben, R., Day, N., & Wareham, N. (2006) · International Journal of Epidemiology · doi:10.1093/ije/dyl079 · Cited by 163 · see citing works
NIH ImageJ and Slice‐O‐Matic Computed Tomography Imaging Software to Quantify Soft Tissue
Irving, B. A., Weltman, J. Y., Brock, D. W., Davis, C. K., Gaesser, G. A., & WELTMAN, A. L. (2007) · Obesity · doi:10.1038/oby.2007.573 · Cited by 158 · see citing works
“For example, review of limited data in the literature regarding impact of lifestyle interventions on AVF reduction suggest that a reduction in AVF of (cid:8) 20 to 40 cm 2 (SD (cid:2) (cid:8) 22 cm 2 ) is reasonable with diet and/or exercise training in obese individuals (21–24).”
MethodSarrafzadegan, N. (2009) · Bulletin of the World Health Organization · doi:10.2471/blt.07.049841 · Cited by 151 · see citing works
Innovative techniques to address retention in a behavioral weight-loss trial
Goldberg, J. H., & Kiernan, M. (2004) · Health Education Research · doi:10.1093/her/cyg139 · Cited by 151 · see citing works
“…although a few recent trials have also had little dropout (3–9%), the trials had weekly contact with participants throughout the trial and/or the trials were shorter in total duration (6–12 months total) (Blumenthal et al., 2000; Stevens et al., 2001; Irwin et al., 2003; Jakicic et al., 2003).”
BackgroundIftikhar, I. H., Bittencourt, L., Youngstedt, S. D., Ayas, N., Cistulli, P. A., Schwab, R. J., Durkin, M. W., & Magalang, U. J. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.06.001 · Cited by 150 · see citing works
Kuna, S. T., Reboussin, D. M., Strotmeyer, E. S., Millman, R. P., Zammit, G., Walkup, M. P., Wadden, T. A., Wing, R. R., Pi-Sunyer, F. X., Spira, A. P., et al. (2021) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201912-2511oc · Cited by 151 · see citing works
“It is possible that ILI could have resulted in fat redistribution (34, 35).”
BackgroundPublic health campaigns and obesity - a critique
Walls, H., Peeters, A., Proietto, J., & McNeil, J. J. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-136 · Cited by 150 · see citing works
“Given the uncertainty of the balance between ‘benefit’ and harm associated with community-based programmes and social marketing campaigns that specifically target the undesirability of obesity, the approach to controlling the increasing prevalence of this condition should shift towards dietary and physical activity in…”
BackgroundBooth, H. P., Prevost, T. A., Wright, A. J., & Gulliford, M. C. (2014) · Family Practice · doi:10.1093/fampra/cmu064 · Cited by 144 · see citing works
“The intervention itself consisted of exercise sessions with a physiologist three times per week for 3 months at a University facility, followed by 9 months of weekly sessions at the facility plus home-based activities (11).”
BackgroundMethodEffect of Exercise on Serum Androgens in Postmenopausal Women: A 12-Month Randomized Clinical Trial
McTiernan, A., Tworoger, S. S., Rajan, K. B., Yasui, Y., Sorenson, B., Ulrich, C. M., Chubak, J., Stanczyk, F. Z., Bowen, D. J., Irwin, M. L., et al. (2004) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.1099.13.7 · Cited by 148 · see citing works
Self-citationEriksson, M. K., Westborg, C.-J., & Eliasson, M. (2006) · Scandinavian Journal of Public Health · doi:10.1080/14034940500489826 · Cited by 146 · see citing works
Aiello, E. J., Yasui, Y., Tworoger, S. S., Ulrich, C. M., Irwin, M. L., Bowen, D. J., Schwartz, R. S., Kumai, C., Potter, J. D., & McTiernan, A. (2004) · Menopause The Journal of The North American Menopause Society · doi:10.1097/01.gme.0000113932.56832.27 · Cited by 145 · see citing works
“6) in maximal oxygen consumption.(24) Approximately 54% of all women reported having at least one menopause symptom within the month before randomization (Table 2).”
BackgroundSelf-citationWitham, M. D., & Avenell, A. (2010) · Age and Ageing · doi:10.1093/ageing/afp251 · Cited by 141 · see citing works
“Two trials did not report giving physical activity advice [10, 15], and three trials provided facilities for undertaking physical activity [12, 13, 17, 18].”
BackgroundMethodInfluentialPhysical Activity and Rapid Decline in Kidney Function Among Older Adults
Robinson‐Cohen, C. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.438 · Cited by 141 · see citing works
Physical Activity, Obesity and Cardiovascular Diseases
Lakka, T. A., & Bouchard, C. (2005) · Handbook of experimental pharmacology · doi:10.1007/3-540-27661-0_4 · Cited by 140 · see citing works
Abdominal adiposity and hot flashes among midlife women
Thurston, R. C., Sowers, M. R., Sutton-Tyrrell, K., Everson‐Rose, S. A., Lewis, T. T., Edmundowicz, D., & Matthews, K. A. (2008) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e31815879cf · Cited by 134 · see citing works
Haakstad, L. A. H., & Bø, K. (2011) · The European Journal of Contraception & Reproductive Health Care · doi:10.3109/13625187.2011.560307 · Cited by 134 · see citing works
“In accordance with the recommendations of Irwin et al.20, perprotocol analysis was based on adherence to 80% of the recommended exercise sessions ( 19 exercise sessions).”
MethodExercise and Biomarkers for Cancer Prevention Studies
Campbell, K. L., & McTiernan, A. (2007) · Journal of Nutrition · doi:10.1093/jn/137.1.161s · Cited by 131 · see citing works
Self-citationAerobic Exercise and Weight Loss in Adults
Jayedi, A., Soltani, S., Emadi, A., Zargar, M.-S., & Najafi, A. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.52185 · Cited by 132 · see citing works
Physical activity and the prevention of cardiovascular disease
Bassuk, S. S., & Manson, J. E. (2003) · Current Atherosclerosis Reports · doi:10.1007/s11883-003-0053-7 · Cited by 136 · see citing works
Merlotti, C., Ceriani, V., Morabito, A., & Pontiroli, A. E. (2017) · International Journal of Obesity · doi:10.1038/ijo.2017.31 · Cited by 132 · see citing works
Friedenreich, C. M., Woolcott, C. G., McTiernan, A., Terry, T., Brant, R., Ballard-Barbash, R. R., Irwin, M. L., Jones, C., Boyd, N. F., Yaffe, M. J., et al. (2010) · International Journal of Obesity · doi:10.1038/ijo.2010.147 · Cited by 127 · see citing works
Self-citationKallings, L., Johnson, J. S., Fisher, R. M., Fairé, U. D., Ståhle, A., Hemmingsson, E., & Hellénius, M.-L. (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32831e953a · Cited by 126 · see citing works
Friedenreich, C. M., Neilson, H. K., Woolcott, C. G., McTiernan, A., Wang, Q., Ballard-Barbash, R., Jones, C. A., Stanczyk, F. Z., Brant, R. F., Yasui, Y., et al. (2011) · Endocrine Related Cancer · doi:10.1530/erc-10-0303 · Cited by 124 · see citing works
Self-citationRETRACTED: Obesity and physical activity: A review
Bensimhon, D., Kraus, W. E., & Donahue, M. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.03.005 · Cited by 122 · see citing works
RetractedRetirement and Physical Activity
Chung, S., Domino, M. E., Stearns, S. C., & Popkin, B. M. (2009) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2009.01.026 · Cited by 122 · see citing works
- Authors
- 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.
- Affiliations
- Yale University (US)
- University of Washington (US)
- Corresponding author
- McTiernan, Anne
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-01-15
- Volume
- 289
- Issue
- 3
- Pages
- 323
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2110141259
- Cited by
- 517
- References
- 35
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 12 · 2021: 16 · 2020: 17 · 2019: 8 · 2018: 16 · 2017: 15 · 2016: 26 · 2015: 19 · 2014: 24 · 2013: 29 · 2012: 28
- FWCI
- 20.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (R01-69334)
- National Institute on Aging (AG1094)
- National Cancer Institute (T32 CA09661, T32CA009661)
- National Center for Research Resources (M01-RR 00037, M01RR000037)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- physical activity, postmenopausal women, intra-abdominal fat, total body fat, subcutaneous abdominal fat, obesity, overweight, weight loss, moderate-intensity exercise, home-based exercise, walking, waist circumference, dose-response relationship, sedentary women
- MeSH terms
- Abdomen, Adipose Tissue, Aged, Body Composition, Female, Humans, Middle Aged, Obesity, Weight Loss, Exercise, Body Mass Index, Postmenopause
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