Cited by 158Obesity, Physical Activity, DietPhysical Activity and HealthCardiovascular and exercise physiology

The DOI matches its Crossref record; 149 of the 149 references it cites were found in a registry or an index; none of the 88 sources its claims cite is checked for support yet.

Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18–65 years old) who are overfat, or obese; systematic review and meta-analysis

Open access
Clark, James E·2015·Journal of Diabetes & Metabolic Disorders

Abstract

There are number of means of methods to alter body composition, and metabolic issues, available for the adult who is overfat. The following is a systematic review and meta-analysis focused on comparing changes from treatment program for adults who are overfat based on analysis of aggregated effect size (ES) of inducing changes. So as to determine the relative effectiveness of such protocols and intervention plans of choice. This tiered meta-analysis of 66-population based studies, and 162-studywise groups, a clear pattern of ES being established across and within treatments. First, hypocaloric balance is necessary for changing body composition, but the effectiveness for establishing imbalance does not equate with the effectiveness for body compositional changes, or any biomarkers associated with metabolic issues. With analysis showing that there is a necessity to include exercise in combination with diet effectively elicit changes in body composition and biomarkers of metabolic issues. More importantly, the combination, resistance training (RT) was more effective than endurance training (ET) or combination of RT and ET, particularly when progressive training volume of 2-to-3 sets for 6-to-10 reps at an intensity of ≥75% 1RM, utilizing whole body and free-weight exercises, at altering body compositional measures (ES of 0.47, 0.30, and 0.40 for loss of BM, FM, and retention of FFM respectively) and reducing total cholesterol (ES = 0.85), triglycerides (ES = 0.86) and low-density lipoproteins (ES = 0.60). Additionally RT was more effective at reducing fasting insulin levels (ES = 3.5) than ET or ET and RT. Even though generally lower ES than RT, the inclusion of ET was more effective when performed at high intensity (e.g. ≥70% VO 2max or HR max for 30-minutes 3-4x’s/wk), or in an interval training style than when utilizing the relatively common prescribed method of low-to-moderate (e.g., 50-70% VO 2max or HR max for at least equal time) steady state method, ES of 0.35, 0.39, and 0.13 for BM, FM, and FFM respectively. Thus indicating that focus of treatment should be on producing a large metabolic stress (as induced by RT or high levels of ET) rather than an energetic imbalance for adults who are overfat.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 66 population-based studies and 162 study groups found that exercise-containing treatments, especially resistance training combined with diet, generally produced larger effect sizes for body composition and some metabolic markers than diet alone. The paper argues treatment focus should be on producing metabolic stress rather than assumed acute energetic imbalance.

Key findings

  • Resistance training (RT) was more effective than endurance training (ET) or combined RT+ET for altering body composition, particularly with progressive training of 2–3 sets for 6–10 reps at ≥75% 1RM using whole-body and free-weight exercises: ES 0.47 for body mass loss, 0.30 for fat mass loss, and 0.40 for fat-free mass retention.
  • RT was also more effective for reducing total cholesterol (ES = 0.85), triglycerides (ES = 0.86), low-density lipoproteins (ES = 0.60), and fasting insulin (ES = 3.5) than ET or ET+RT.
  • High-intensity or interval ET was more effective than low-to-moderate steady-state ET, with ES of 0.35 for body mass, 0.39 for fat mass, and 0.13 for fat-free mass.
  • Hypocaloric balance was necessary for changing body composition, but the effectiveness for establishing energetic imbalance did not equate with effectiveness for body compositional changes or associated biomarkers.

Methods

  • Systematic review and meta-analysis of human population-based studies retrieved from PubMed, EBSCO Host (CINAHL, SPORTDiscus), and Scopus, with inclusion criteria requiring adults aged 18–65 years classified as overweight or obese, chronic interventions of at least 4 weeks, and randomized assignment to training/control or intervention order.
  • A total of 66 studies and 162 study groups were included; 32 studies indicated a control group for pooled therapeutic effect size analysis.
  • Standardized effect sizes and 95% confidence intervals were calculated and pooled across treatment categories (diet only, diet+ET, diet+RT, diet+ET+RT, ET only, RT only), with 2×2 χ² analyses used to compare response levels by treatment, exercise subtype, diet type, and intervention length.

Limitations

  • Stated: too few studies examined anabolic hormones such as testosterone and growth hormone without pharmaceutical intervention, limiting speculation about the extent or timeframe of hormonal changes.
  • Stated: energetic imbalance was generally assumed rather than directly measured; very few protocols directly measured the energetic shift from exercise sessions or recovery, and no reviewed study directly measured it.
  • Evident from the text: studies were pooled regardless of intervention duration or unique characteristics, many cells had insufficient responses for pooled ES or CI, and several comparisons relied on trends or borderline significance (e.g., p = 0.055, p = 0.06–0.12).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s40200-015-0154-1

Cites

149 of 149 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Description summarizing the steps for inclusion/exclusion and method leading to classification and analysis of studies involved within the meta-analysis.
Figure 1 Description summarizing the steps for inclusion/exclusion and method leading to classification and analysis of studies involved within the meta-analysis.CC BY · PubMed Central
Figure 2 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of ET, or versus diet with combination of RT) methods for changes in either Body Mass (BM), Fat Mass (Fat), and Fat-Free Mass (FFM). Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.
Figure 2 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of ET, or versus diet with combination of RT) methods for changes in either Body Mass (BM), Fat Mass (Fat), and Fat-Free Mass (FFM). Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 3 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of either ET, RT, or combination of ET and RT) methods for changes in energetic imbalance as assumed established within the intervention protocol. Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.
Figure 3 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of either ET, RT, or combination of ET and RT) methods for changes in energetic imbalance as assumed established within the intervention protocol. Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 4 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 4 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 5 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination ET) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 5 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination ET) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 6 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of RT) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 6 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of RT) methods for response related to changes in blood lipid profiles TC, HDL, LDL, and TG. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 7 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of ET, or versus diet with combination of RT) methods for response related to changes in Insulin. Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.
Figure 7 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone or versus diet with combination of ET, or versus diet with combination of RT) methods for response related to changes in Insulin. Note that the comparisons are labeled as “treatment-to-comparison”, with D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, D(E + R) indicating diet with ET and RT, ET indicating ET-only, and RT indicating RT-only for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 8 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 8 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet alone) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 9 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of ET) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 9 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of ET) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central
Figure 10 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of RT) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.
Figure 10 Description of the pooled ES for treatment response and the range of CI for ES between intervention (versus diet with combination of RT) methods for response related to changes in Adiponectin, Leptin, CRP, TNF- α and IL-6. Note that labeled groups go as follows: D indicating diet-only, D(E) indicating diet with ET, D(R) indicating diet with RT, and D(E + R) indicating diet with ET and RT for the various intervention methods within the comparisons.CC BY · PubMed Central

Verification

Claims the paper makes

97 Own result · 25 No basis given · 20 Own method · 16 Not checked yet · 15 Own interpretation

Verify all 88 references — free account
  • It may state two separate claims as one. 24
  • The quote only partly states this claim. 7
  • Probably not a substantial claim. 32
57 of 57
  • The authors state this as an assumption.

    There are differences in energetic balance across the various treatment interventions.

    “Lastly, as related to changes in caloric (energetic) balance there were no differences noted between any of the pooled ES for the assumed differences in energetic balance across the various treatment interventions.”
  • The authors state this as an assumption.

    The energetic imbalances indicated in the reviewed studies are assumed differences in energetic balance, not directly measured.

    “Principally that the indicated energetic imbalances are an assumed difference in energetic balance.”
  • The authors state this as an assumption.

    The relationship between caloric imbalance and body composition changes is classically assumed to be one of equivalence.

    “Where if the assumption is correct, there should be a relationship of equivalence in effectiveness for changing caloric balance with body compositional changes between treatment methods.”
  • The paper relies on this without support.

    Changes in body composition and health status in overfat adults arise from a highly elaborate network of interacting factors that confound each other's impact.

    “As changes to not only body composition but also health status comes from manipulation of highly elaborate network of factors that interact, compliment and confound the impact of each other for the adult who is overfat leading to not only body compositional changes, but reversal of the deleterious health outcome of being overfat.”
4 of 4

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Citations

Cites

Show all 149 references

Research works printed but not linked: 1

  1. Clark JE. Role of resistance training in obesity treatments. 1st International Conference on Obesity, OMICS. Philadelphia, PA, 2012.

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Metadata

Authors
Clark, J. E.
Affiliations
Manchester Community College - Connecticut (US)
Corresponding author
Clark, James E
Venue
Journal of Diabetes & Metabolic Disorders
Published
2015-04-17
Volume
14
Issue
1
Pages
31-31
ISSN
2251-6581 (ISSN-L)
OpenAlex
W2122502708
Cited by
158
References
149
Citations by year
2026: 6 · 2025: 15 · 2024: 11 · 2023: 13 · 2022: 19 · 2021: 22 · 2020: 14 · 2019: 14 · 2018: 12 · 2017: 15 · 2016: 13 · 2015: 4
FWCI
2.13
Type
journal article
Language
en
Update notices
erratum (2015-09-28)
Open access
Locations
  • Journal of Diabetes & Metabolic Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Keywords
weight loss, obesity, diet, physical activity, resistance training, endurance training, interval training, body composition, fat-free mass, fat mass, metabolic stress, fasting insulin, cholesterol, triglycerides, low-density lipoprotein, high-intensity exercise, metabolic health, adults, treatment effectiveness comparison, free weight exercises, metabolic biomarkers

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