title: Weight loss, exercise, or both and physical function in obese older adults. Effect of long-term changes in diet and exercise on plasma leptin concentrations. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Long-term (1- and 2-year) effects of lifestyle intervention in type 2 diabetes relatives. Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial. Effects of the amount and intensity of exercise on plasma lipoproteins. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes Effects of low-fat diet, calorie restriction, and running on lipoprotein subfraction concentrations in moderately overweight men. Lifestyle Intervention in Overweight Individuals With a Family History of Diabetes The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. Effect of Diet and Exercise on Body Composition, Energy Intake and Leptin Levels in Overweight Women and Men Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study Effects of walking or resistance training on weight loss maintenance in obese, middle-aged men: a randomized trial Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. Exercise and the maintenance of weight loss: 1-year follow-up of a controlled clinical trial. Comparison of three weight maintenance programs on cardiovascular risk, bone and vitamins in sedentary older adults. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. A worksite program for overweight middle-aged men achieves lesser weight loss with exercise than with dietary change. Comparison of 2-year weight loss trends in behavioral treatments of obesity: diet, exercise, and combination interventions. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial.
abstract: BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) BACKGROUND Although it is known that plasma leptin concentrations correlate with the amount of adipose tissue in the body , little information is available on the long-term effects on leptin concentrations of changes in diet and exercise . OBJECTIVE We wanted to examine whether changes in dietary energy sources and exercise-mediated energy expenditure , alone or in combination , affect plasma leptin concentrations . DESIGN In a r and omized , 2 x 2 factorial trial , 186 men with metabolic syndrome were divided into 4 groups : diet , exercise , a combination of diet and exercise , and control . Data on dietary intake , physical fitness , and demographics were collected and plasma leptin concentrations were measured before and after a 1-y intervention period . RESULTS Plasma leptin concentrations , body mass index , and fat mass decreased in association with long-term reductions in food intake as well as increased physical activity . By adjusting for either body mass index or fat mass , we observed a highly significant reduction in plasma leptin concentration after both the diet and the exercise interventions . There was no interaction between the interventions , suggesting a direct and additive effect of changes in diet and physical activity on plasma leptin concentrations . CONCLUSION Long-term changes in lifestyle consisting of decreased intake of dietary fat and increased physical activity reduced plasma leptin concentrations in humans beyond the reduction expected as a result of changes in fat mass BACKGROUND Persistent , low- grade inflammation is an independent predictor of several chronic diseases and all-cause mortality . OBJECTIVE The intention of this study was to determine the independent and combined effects of diet-induced weight loss and exercise on markers of chronic inflammation . DESIGN Three hundred sixteen community-dwelling , older ( > or = 60 y ) , overweight or obese [ body mass index ( in kg/m2 ) > or = 28 ] , sedentary men and women with radiographic evidence of knee osteoarthritis were r and omly assigned to four 18-mo treatments : healthy lifestyle control , diet-induced weight loss , exercise , and diet plus exercise . The exercise intervention consisted of combined weight training and walking for 1 h 3 times/wk . The weight-loss intervention consisted of a weekly session with a registered dietitian to provide education and support for lowering energy intake . RESULTS The diet-induced weight-loss intervention result ed in significantly greater reductions in concentrations of C-reactive protein ( P = 0.01 ) , interleukin 6 ( P = 0.009 ) , and soluble tumor necrosis factor alpha receptor 1 ( P = 0.007 ) than did no weight-loss treatment . Changes in soluble tumor necrosis factor alpha receptor 1 but not in C-reactive protein or interleukin 6 correlated with changes in body weight .  Exercise training did not have a significant effect on these inflammatory biomarkers , and there was no significant interaction between weight loss and exercise training . CONCLUSIONS These findings provide evidence from a r and omized controlled trial that a dietary intervention design ed to elicit weight loss reduces overall inflammation in older , obese persons . Additional studies are needed to assess the effects of different modes and intensities of exercise on inflammation OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone BACKGROUND Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus , but no large trials have compared interventions . We investigated the effects of diet and physical activity on blood pressure and glucose concentrations . METHODS We did a r and omised , controlled trial in southwest Engl and in adults aged 30 - 80 years in whom type 2 diabetes had been diagnosed 5 - 8 months previously . Participants were assigned usual care ( initial dietary consultation and follow-up every 6 months ; control group ) , an intensive diet intervention ( dietary consultation every 3 months with monthly nurse support ) , or the latter plus a pedometer-based activity programme , in a 2:5:5 ratio . The primary endpoint was improvement in glycated haemoglobin A(1c)(HbA(1c ) ) concentration and blood pressure at 6 months . Analysis was done by intention to treat . This study is registered , number IS RCT N92162869 . FINDINGS Of 593 eligible individuals , 99 were assigned usual care , 248 the diet regimen , and 246 diet plus activity . Outcome data were available for 587 ( 99 % ) and 579 ( 98 % ) participants at 6 and 12 months , respectively . At 6 months , glycaemic control had worsened in the control group ( mean baseline HbA(1c ) percentage 6·72 , SD 1·02 , and at 6 months 6·86 , 1·02 ) but improved in the diet group ( baseline-adjusted difference in percentage of HbA(1c ) -0·28 % , 95 % CI -0·46 to -0·10 ; p=0·005 ) and diet plus activity group ( -0·33 % , -0·51 to -0·14 ; p<0·001 ) . These differences persisted to 12 months , despite less use of diabetes drugs . Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups . Blood pressure was similar in all groups . INTERPRETATION An intensive diet intervention soon after diagnosis can improve glycaemic control . The addition of an activity intervention conferred no additional benefit . FUNDING Diabetes UK and the UK Department of Health BACKGROUND Caloric restriction ( CR ) increases maximal life span in short-lived organisms , and its effects are being explored in nonhuman primates . The objectives of this study were to determine the feasibility of prolonged CR in nonobese adults and to compare the effects of CR- and exercise-induced weight loss on body composition and abdominal adiposity . METHODS A r and omized , controlled trial was conducted with 48 healthy , nonobese women and men , aged 57 + /- 1 ( mean + /- st and ard error [ SE ] ) years , with body mass index 27.3 + /- 0.3 kg/m2 . Participants were r and omly assigned to a 20 % calorically-restricted diet ( CR , n = 19 ) , exercise design ed to produce a similar energy deficit ( EX , n = 19 ) , or a healthy lifestyle control group ( HL , n = 10 ) for 1 year . Assessment s included weight , body composition by dual-energy x-ray absorptiometry , abdominal adipose tissue by magnetic resonance imaging , and energy intake by doubly labeled water . RESULTS The average level of CR achieved by the CR group was 11.5 + /- 2.1 % , and the EX group completed 59 + /- 6.7 % of their prescribed exercise . Weight changes were greater ( p < or=.0005 ) in the CR ( -8.0 + /- 0.9 kg ) and EX ( -6.4 + /- 0.9 ) groups as compared to the HL group ( -1.3 + /- 0.9 kg ) , corresponding to reductions of 10.7 % , 8.4 % , and 1.7 % of baseline weights , respectively . Whole-body fat mass and visceral and subcutaneous abdominal adipose tissue decreased significantly ( p < .005 ) and comparably in the CR and EX groups , but did not change in the HL group . CONCLUSIONS CR for 1 year was feasible , but the level of CR achieved was less than prescribed . CR and exercise were equally effective in reducing weight and adiposity Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIMS To study the long-term ( 1- and 2-year ) effect of a lifestyle intervention on non-diabetic first-degree relatives of type 2 diabetic patients , i.e. , the 1-year effect of diet versus diet and exercise in relation to a control group and the 2-year sustainability of these treatment effects . METHOD Seventy-seven healthy first-degree relatives ( men and women ) between the ages of 25 and 55 were allocated to one of three groups : diet group ( D ) , diet and exercise group ( DE ) and control group ( C ) . For ethical reasons , after 1 year the control group began the intervention and were followed for another 2 years . Diet and physical activity counselling was based on current nutrition recommendations , including increased intake of fatty fish and low glycaemic index foods . The fatty acid composition of the erythrocyte membrane was studied as an objective measure of dietary change . Assessment s included fasting insulin , 2-h insulin , oral glucose tolerance test ( OGTT ) , anthropometry and blood lipid measurements . Groups D and DE received intensive follow-up through unannounced telephone interviews during the first 4 months . RESULTS Dietary changes were significant at 1 year , and to a large degree sustained at 2 years . Adherence to advice regarding fat quality was confirmed through changes in the fatty acid composition of the erythrocyte membrane . The least active subjects in DE increased their physical activity ( PA ) . At 1 year , group D showed a reduction in the ratio of LDL to HDL cholesterol ( p=0.028 ) while group DE decreased their body weight by 2.7 % ( p<0.029 ) and increased HDL ( p<0.037 ) versus controls . At 2 years , cholesterol levels ( total , LDL and the ratio LDL/HDL ) were reduced within group D and when compared to DE ( p=0.022 , 0.009 , 0.035 , respectively ) . Fasting insulin was reduced within group DE and when compared to group D ( p=0.025 ) . CONCLUSIONS Positive changes in lifestyle , blood lipids and fasting insulin can be achieved and maintained in a non-diabetic population at risk of type 2 diabetes after 2 years BACKGROUND Maintenance of weight loss is a core problem in the treatment of obesity . Physical activity may improve maintenance and metabolic risk factors associated with obesity . HYPOTHESES ( 1 ) A walking training program of moderate intensity , started after weight reduction by a very-low-energy diet , improves maintenance of weight loss and obesity-related metabolic disorders ; and ( 2 ) the effect of the training program is related to the prescribed amount of physical activity , ie , a higher amount ( energy expenditure ) leads to more favorable results . METHODS The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2 ) . Eighty-two participants were r and omized to this study ; 74 participated in the follow-up assessment . A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program r and omized in 3 groups : a control group with no increase in habitual exercise and with counseling on diet and relapse prevention ; a walk-1 group , with a walking program targeted to expend 4.2 MJ/wk and diet counseling ; and a walk-2 group , with a walking program of 8 . 4 MJ/wk and diet counseling . R and om permuted blocks within strata were used , with weight loss ( in 3 classes ) as the stratifying factor . After the intervention , the subjects were followed up for 2 years . MAIN OUTCOME MEASURES Primary outcomes were body weight , fat mass , and waist circumference at the 2-year follow-up . Secondary outcomes were the levels of serum lipoproteins and lipids , plasma glucose , insulin , and blood pressure . RESULTS The mean weight loss after weight reduction was 13.1 kg . The main outcome variables remained stable during the maintenance program , but increased during the follow-up period . Compared with the end of weight reduction , weight regain at the 2-year follow-up was 3.5 kg less ( 95 % confidence interval , 0.2 - 6.8 ) and waist circumference regain 3.8 cm less ( 95 % confidence interval , 0.3 - 7.3 ) in the walk-1 group vs controls . The secondary outcomes showed a partial relapse during the maintenance program , and a further regain during the follow-up period . CONCLUSIONS Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference BACKGROUND Increased physical activity is related to reduced risk of cardiovascular disease , possibly because it leads to improvement in the lipoprotein profile . However , the amount of exercise training required for optimal benefit is unknown . In a prospect i ve , r and omized study , we investigated the effects of the amount and intensity of exercise on lipoproteins . METHODS A total of 111 sedentary , overweight men and women with mild-to-moderate dyslipidemia were r and omly assigned to participate for six months in a control group or for approximately eight months in one of three exercise groups : high-amount-high-intensity exercise , the caloric equivalent of jogging 20 mi ( 32.0 km ) per week at 65 to 80 percent of peak oxygen consumption ; low-amount-high-intensity exercise , the equivalent of jogging 12 mi ( 19.2 km ) per week at 65 to 80 percent of peak oxygen consumption ; or low-amount-moderate-intensity exercise , the equivalent of walking 12 mi per week at 40 to 55 percent of peak oxygen consumption . Subjects were encouraged to maintain their base-line body weight . The 84 subjects who complied with these guidelines served as the basis for the main analysis . Detailed lipoprotein profiling was performed by nuclear magnetic resonance spectroscopy with verification by measurement of cholesterol in lipoprotein subfractions . RESULTS There was a beneficial effect of exercise on a variety of lipid and lipoprotein variables , seen most clearly with the high amount of  high-intensity exercise .  The high amount of exercise result ed in greater improvements than did the lower amounts of exercise ( in 10 of 11 lipoprotein variables ) and was always superior to the control condition ( 11 of 11 variables ) . Both lower-amount exercise groups always had better responses than the control group ( 22 of 22 comparisons ) . CONCLUSIONS The highest amount of weekly exercise , with minimal weight change , had widespread beneficial effects on the lipoprotein profile . The improvements were related to the amount of activity and not to the intensity of exercise or improvement in fitness Lifestyle interventions for weight loss are the cornerstone of obesity therapy , yet their optimal design is debated . This is particularly true for postmenopausal women ; a population with a high prevalence of obesity yet toward whom fewer studies are targeted . We conducted a year-long , 4-arm r and omized trial among 439 overweight-to-obese postmenopausal sedentary women to determine the effects of a calorie-reduced , low-fat diet ( D ) , a moderate-intensity , facility-based aerobic exercise program ( E ) , or the combination of both interventions ( D+E ) , vs. a no-lifestyle-change control ( C ) on change in body weight and composition . The group-based dietary intervention had a weight-reduction goal of ≥10 % , and the exercise intervention consisted of a gradual escalation to 45-min aerobic exercise 5 day/week . Participants were predominantly non-Hispanic whites ( 85 % ) with a mean age of 58.0 ± 5.0 years , a mean BMI of 30.9 ± 4.0 kg/m(2 ) and an average of 47.8 ± 4.4 % body fat .  Baseline and 12-month weight and adiposity measures were obtained by staff blinded to participants ' intervention assignment . Three hundred and ninety nine women completed the trial ( 91 % retention ) . Using an intention-to-treat analysis , average weight loss at 12 months was -8.5 % for the D group ( P < 0.0001 vs. C ) , -2.4 % for the E group ( P = 0.03 vs. C ) , and -10.8 % for the D+E group ( P < 0.0001 vs. C ) , whereas the C group experienced a nonsignificant -0.8 % decrease . BMI , waist circumference , and % body fat were also similarly reduced . Among postmenopausal women , lifestyle-change involving diet , exercise , or both combined over 1 year improves body weight and adiposity , with the greatest change arising from the combined intervention Summary Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 ( non-insulin-dependent ) diabetic subjects . In Study 1 , 25 subjects were r and omly assigned to diet plus moderate exercise or diet plus placebo exercise .  All subjects exercised twice a week as a group and once a week on their own ; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics . All subjects followed a calorie-counting diet and were taught behaviour modification strategies . Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up . In Study 2 , more extreme conditions were compared : a diet only group and a diet plus exercise group . The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own , while the diet only group was instructed to maintain their current low level of activity . Both groups received comparable diet and behaviour modification instruction and therapist contacts . The diet plus exercise group had significantly ( p<0.01 ) better weight losses than the diet only condition at the end of the 10 week programme ( −9.3 kg vs −5.6 kg ) and at 1 year follow-up ( −7.9 kg vs −3.8 kg ) . Both groups had similar improvements in glycosylated haemoglobin , but reductions in medication were more frequent and greater in magnitude in the diet plus exercise group . Finally , analyses were conducted collapsing across studies and across treatment groups and comparing subjects who reported low , medium , or high levels of exercise at 1 year . Self-reported exercise was related to weight loss and to improvements in glycosylated haemoglobin , even after adjusting for weight loss . These data suggest that the combination of diet and exercise  improves weight loss and glycaemic control compared to diet only in Type 2 diabetic patients We studied the effects of exercise ( primarily running ) , calorie restriction ( dieting ) , and a low-fat , high-carbohydrate diet on changes in lipoprotein subfractions in moderately overweight men in a r and omized controlled clinical trial . After 1 year , complete data were obtained for 39 men assigned to lose weight through dieting without exercise , 37 men assigned to lose weight through dieting with exercise ( primarily running ) , and 40 nondieting sedentary controls .  We instructed both diet groups to consume no more than 30 % total fat , 10 % saturated fat , and 300 mg/d of cholesterol , and at least 55 % carbohydrates , and the controls were instructed to maintain their usual food choices . Analytic ultracentrifugation was used to measure changes in plasma lipoprotein mass concentrations . In addition , the absorbance of protein-stained polyacrylamide gradient gels was used as an index of concentrations for five high-density lipoprotein ( HDL ) subclasses that have been identified by their particle sizes , ie , HDL3c ( 7.2 to 7.8 nm ) , HDL3b ( 7.8 to 8.2 nm ) , HDL3a ( 8.2 to 8.8 nm ) , HDL2a ( 8.8 to 9.7 nm ) , and HDL2b ( 9.7 to 12 nm ) . Relative to controls , weight decreased significantly in men who dieted with exercise ( net difference + /- SE , -3.3 + /- 0.4 kg/m2 ) and in men who dieted without exercise ( -2.0 + /- 0.4 kg/m2 ) . Dieting with exercise significantly decreased very-low-density lipoprotein (VLDL)-mass concentrations and significantly increased plasma HDL2-mass , HDL3a , HDL2a , and HDL2b relative to both control and dieting without exercise . There were no significant changes in lipoprotein mass and HDL protein for dieters who did not run . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To assess the effect of lifestyle intervention over 2 years on changes in weight , coronary heart disease ( CHD ) risk factors , and incidence of diabetes in overweight individuals with a parental history of diabetes . RESEARCH DESIGN AND METHODS Participants ( n = 154 ) , who were 30–100 % over ideal body weight , had one or both parents with diabetes , and were currently nondiabetic , were r and omly assigned to 2-year treatments focused on diet ( decreasing calories and fat intake ) , exercise ( goal of 1,500 kcal/week of moderate activity ) , or the combination of diet plus exercise or to a no-treatment control group . Subjects were reassessed at 6 months , 1 year , and 2 years . RESULTS At 6 months , the groups differed significantly on measures of eating , exercise , and fitness ; weight losses in the diet and diet-plus-exercise groups were significantly > in the exercise and control conditions . Weight losses were associated with positive changes in CHD risk factors . After 6 months , there was gradual deterioration of behavioral and physiological changes , so that at 2 years , almost no between-group differences were maintained . Differences between groups in risk of developing diabetes were of borderline significance ( P = 0.08 ) . Strongest predictors were impaired glucose tolerance at baseline , which was positively related to risk of developing diabetes , and weight loss from baseline to 2 years , which was negatively related ; in all treatment groups , a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by ∼ 30 % compared with no weight loss . CONCLUSIONS Although initially successful , the interventions studied here were not effective in producing long-term changes in behavior , weight , or physiological parameters . However , weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes . Since modest weight loss significantly reduced risk of type 2 diabetes , further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss BACKGROUND The National Cholesterol Education Program ( NCEP ) recommends a low-saturated-fat , low-cholesterol diet , with weight loss if indicated , to correct elevated plasma cholesterol levels . Weight loss accomplished by simple caloric restriction or increased exercise typically increases the level of high-density lipoprotein ( HDL ) cholesterol . Little is known about the effects on plasma lipoproteins of a hypocaloric NCEP diet with or without exercise in overweight people . METHODS We tested the hypothesis that exercise ( walking or jogging ) will increase HDL cholesterol levels in moderately overweight , sedentary people who adopt a hypocaloric NCEP diet . We r and omly assigned 132 men and 132 women 25 to 49 years old to one of three groups : control , hypocaloric NCEP diet , or hypocaloric NCEP diet with exercise .  One hundred nineteen of the men and 112 of the women returned for testing after one year . RESULTS After one year , the subjects in both intervention groups had reached or closely approached NCEP Step 1 dietary goals and reduced their mean body fat significantly ( range of reduction in mean fat weight , 4.0 to 7.8 kg ) . Weight loss on the NCEP diet alone did not significantly change HDL cholesterol levels in either the men or the women as compared with the subjects in the control group . Plasma levels of HDL cholesterol increased significantly more in the men who exercised and dieted ( mean [ + /- SE ] change , + 13 + /- 3 percent ) than in the men who only dieted ( + 2 + /- 3 percent , P less than 0.01 ) or the men who acted as controls ( -4 + /- 2 percent , P less than 0.001 ) . HDL cholesterol levels remained about the same in the women who exercised and dieted ( + 1 + /- 2 percent ) ; they were higher than in the women who only dieted ( -10 + /- 3 percent , P less than 0.01 ) , but not higher than in the controls ( -3 + /- 3 percent ) . CONCLUSIONS Regular exercise in overweight men and women enhances the improvement in plasma lipoprotein levels that results from the adoption of a low-saturated-fat , low-cholesterol diet Objective : To investigate the effect of diet alone ( D ) , exercise alone ( E ) , and a combination of diet and exercise ( DE ) on body weight , body composition , energy intake , blood pressure , serum lipid and leptin levels , and fitness levels in mildly obese sedentary women and men . Design : The three interventions were compared in a r and omized longitudinal study design . The exercise programs were supervised for six months , after which participants in E and DE were provided with exercise equipment to take home . Subjects : 90 adult overweight women and men ( age : 44.2 ± 7.2 years ; BMI = 30.5 ± 2.7 kg/m2 ) . Measurements : Body weight , body composition , waist and hip circumferences , blood pressure , serum lipid levels , and fitness levels were evaluated at 0 , 3 , 6 , 9 , and 12 months . Serum leptin concentrations were measured at 0 and 6 months only . Results : At 6 and 9 months in women , and 9 months in men , DE demonstrated a significant loss of body weight compared to both D and E ( p < 0.05 ) . Serum leptin levels significantly decreased from baseline to 6 months in women in D ( p = 0.05 ) and DE ( p = 0.0003 ) and men in E ( p = 0.038 ) . At one year , no significant differences existed among groups in any of the measures . Conclusion : A combination of diet and exercise result ed in a significant decrease in body weight in women and men ; but this decrease was not maintained at one year follow-up . Serum leptin concentrations showed significant within-group decreases , but were not different among groups . A supervised diet and exercise program is effective for weight loss ; however , once intensive participant-investigator and participant-participant contact is discontinued , weight regain ensures BACKGROUND Guidelines established by the National Cholesterol Education Program ( NCEP ) promote exercise and weight loss for the treatment of abnormal lipoprotein levels . Little is known , however , about the effects of exercise or the NCEP diet , which is moderately low in fat and cholesterol , in persons with lipoprotein levels that place them at high risk for coronary heart disease . METHODS We studied plasma lipoprotein levels in 180 postmenopausal women , 45 through 64 years of age , and 197 men , 30 through 64 years of age , who had low high-density lipoprotein ( HDL ) cholesterol levels ( < or = 59 mg per deciliter in women and < or = 44 mg per deciliter in men ) and moderately elevated levels of low-density lipoprotein ( LDL ) cholesterol ( > 125 mg per deciliter but < 210 mg per deciliter in women and > 125 mg per deciliter but < 190 mg per deciliter in men ) . The subjects were r and omly assigned to aerobic exercise , the NCEP Step 2 diet , or diet plus exercise , or to a control group , which received no intervention . RESULTS Dietary intake of fat and cholesterol decreased during the one-year study ( P<0.001 ) , as did body weight , in women and men in either the diet group or the diet-plus-exercise group , as compared with the controls ( P<0.001 ) and the exercise group ( P<0.05 ) , in which dietary intake and body weight were unchanged . Changes in HDL cholesterol and triglyceride levels and the ratio of total to HDL cholesterol did not differ significantly among the treatment groups , for subjects of either sex . The serum level of LDL cholesterol was significantly reduced among women ( a decrease of 14.5+/-22.2 mg per deciliter ) and men ( a decrease of 20.0+/-17.3 mg per deciliter ) in the diet-plus-exercise group , as compared with the control group ( women had a decrease of 2.5+/-16.6 mg per deciliter , P<0.05 ; men had a decrease of 4.6+/-21.1 mg per deciliter , P<0.001 ) . The reduction in LDL cholesterol in men in the diet-plus-exercise group was also significant as compared with that among the men in the exercise group ( 3.6+/-18.8 mg per deciliter , P<0.001 ) . In contrast , changes in LDL cholesterol levels were not significant among the women ( a decrease of 7.3+/-18.9 mg per deciliter ) or the men ( 10.8+/-18.8 mg per deciliter ) in the diet group , as compared with the controls . CONCLUSIONS The NCEP Step 2 diet failed to lower LDL cholesterol levels in men or women with high-risk lipoprotein levels who did not engage in aerobic exercise . This finding highlights the importance of physical activity in the treatment of elevated LDL cholesterol levels OBJECTIVE Individuals with impaired glucose tolerance ( IGT ) have a high risk of developing NIDDM . The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM , i.e. , reduce the incidence of NIDDM , and thereby reduce the overall incidence of diabetic complications , such as cardiovascular , renal , and retinal disease , and the excess mortality attributable to these complications . RESEARCH DESIGN AND METHODS In 1986 , 110,660 men and women from 33 health care clinics in the city of Da Qing , China , were screened for IGT and NIDDM . Of these individuals , 577 were classified ( using World Health Organization criteria ) as having IGT . Subjects were r and omized by clinic into a clinical trial , either to a control group or to one of three active treatment groups : diet only , exercise only , or diet plus exercise . Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM . Cox 's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment . RESULTS The cumulative incidence of diabetes at 6 years was 67.7 % ( 95 % CI , 59.8–75.2 ) in the control group compared with 43.8 % ( 95 % CI , 35.5–52.3 ) in the diet group , 41.1 % ( 95 % CI , 33.4–49.4 ) in the exercise group , and 46.0 % ( 95 % CI , 37.3–54.7 ) in the diet-plus-exercise group ( P < 0.05 ) . When analyzed by clinic , each of the active intervention groups differed significantly from the control clinics ( P < 0.05 ) . The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight ( BMI < or ≥ 25 kg/m2 ) . In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose , the diet , exercise , and diet-plus-exercise interventions were associated with 31 % ( P < 0.03 ) , 46 % ( P < 0.0005 ) , and 42 % ( P < 0.005 ) reductions in risk of developing diabetes , respectively . CONCLUSIONS Diet and /or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT Objective : To investigate whether walking or resistance training  improves weight maintenance after weight loss when added to dietary counselling . Design : Two months ' weight reduction with very-low-energy-diet ( VLED ) followed by r and omization into three groups ( control , walking , resistance training ) for 6 months ' weight maintenance ( WM ) program and 23 months ' unsupervised follow-up . During VLED and WM all groups received similar dietary counselling . Subjects : The main inclusion criteria were BMI > 30 kg/m2 , waist>100 cm and physical inactivity ( exercise ≤ once a week ) . Ninety healthy , obese ( mean BMI 32.9 kg/m2 and waist 112.5 cm ) , 35–50 y-old men started the study and 68 were measured at the end of the study .  Measurements : Weight and body composition assessed by underwater weighing . Exercise diaries and dietary records to assess energy balance . Results : During VLED the mean body weight decreased from 106.0 ( s.d . 9.9 ) kg to 91.7 ( 9.4 ) kg . Weight was regained mostly during follow-up and in the end of the study the mean weight in groups was 99.9–102.0 kg . Exercise training did not improve short or long-term weight maintenance when compared to the control group . However , resistance training  attenuated the regain of body fat mass during WM ( P=0.0l ) , but not during follow-up . In the combined groups the estimated total energy expenditure ( EE ) of reported physical activity was associated with less weight regain during WM . EE of 10.1 MJ/week was associated with maintaining weight after weight loss . EE of physical activity tended to decrease after WM in exercise groups due to poor long-term adherence to prescribed exercise . Energy intake seemed to increase during follow-up . Conclusion : Exercise training of moderate dose did not seem to improve long-term weight maintenance because of poor adherence to prescribed exercise We studied separately the influence of two methods for losing fat weight on the levels of plasma lipids and lipoproteins in overweight sedentary men --  decreasing energy intake without increasing exercise ( diet ) , and increasing energy expenditure without altering energy intake ( exercise , primarily running)--in a one-year r and omized controlled trial . As compared with controls ( n = 42 ) ,  dieters ( n = 42 ) had significant loss of total body weight ( -7.8 + /- 0.9 kg [ mean + /- SE ] ) , fat weight ( -5.6 + /- 0.8 kg ) , and lean ( non-fat ) weight ( -2.1 + /- 0.5 kg ) ( P less than 0.001 for each variable ) , and  exercisers ( n = 47 ) had significant loss of total body weight ( -4.6 + /- 0.8 kg ) and fat weight ( -3.8 + /- 0.7 kg ) ( P less than 0.001 for both variables ) but not lean weight ( -0.7 + /- 0.4 kg ) . Fat-weight loss did not differ significantly between dieters and exercisers . All subjects were discouraged from altering their diet composition ; however , dieters and exercisers had slight reductions in the percentage of kilojoules derived from fat . As compared with the control group , both weight-loss groups had significant increases ( P less than 0.01 ) in plasma concentrations of high-density lipoprotein ( HDL ) cholesterol ( diet vs. exercise , 0.13 + /- 0.03 vs. 0.12 + /- 0.03 mmol per liter ) , HDL2 cholesterol ( 0.07 + /- 0.02 vs. 0.07 + /- 0.02 mmol per liter ) , and HDL3 cholesterol ( 0.07 + /- 0.02 vs. 0.06 + /- 0.02 mmol per liter ) and significant decreases ( P less than 0.05 ) in triglyceride levels ( diet vs. exercise , -0.35 + /- 0.14 vs. -0.24 + /- 0.12 mmol per liter ) . Levels of total and low-density lipoprotein cholesterol were not significantly changed , relative to values in controls . None of these changes were significantly different between dieters and exercisers . Thus , we conclude that fat loss through dieting or exercising produces comparable and favorable changes in plasma lipoprotein concentrations This study reports results 1 year after treatment for 77 obese women who had been treated for 48 weeks by diet combined with supervised ( a ) aerobic exercise , ( b ) strength training , ( c ) aerobic plus strength training combined , or ( d ) no exercise .  Mean ( + /- SD ) end-of-treatment weight losses for the 4 conditions ranged from 13.5 + /- 9.1 kg to 17.3 + /- 10.3 kg , but there were no statistically significant differences among groups . Participants in all 4 conditions regained approximately 35 % to 55 % of their weight loss in the year after treatment ; again , there were no significant differences among groups . Participants , however , who reported exercising regularly in the 4 months preceding the follow-up assessment regained significantly less weight than did nonexercisers OBJECTIVE Obese patients with knee osteoarthritis ( OA ) are encouraged to lose weight to obtain symptomatic relief . Risk of vascular events is higher in people with OA compared to people without arthritis . Our aim in this r and omized trial was to compare changes in cardiovascular disease ( CVD ) risk-factors , nutritional health , and body composition after 1-year weight-loss maintenance achieved by [D]diet , [E]knee-exercise , or [C]control , following weight loss by low-energy-diet . DESIGN AND METHODS Obese individuals ( n = 192 , > 50 years ) with knee OA , 63 years ( SD 6 ) , weight 103.2 kg ( 15.0 ) , body-mass index 37.3 kg/m(2 ) ( 4.8 ) , were enrolled into a 68-week weight-loss trial . RESULTS Mean changes in weight , in D , E , and C were -11.0 , -6.3 , and -8.3 kg ( P = 0.002 ) . Reduction in waist circumference in D , E , and C were -8.4 , -4.6 , and -7.0 cm ( P = 0.007 ) . D reduced waist circumference significantly more than E : -3.8 cm ( 95%CI -6.2 to -1.4 ; P = 0.0024 ) . There was no difference between the groups in changes in CVD risk factors ; blood pressure , triglycerides , and cholesterol . Nutritional health was improved in all groups . For markers of bone , no statistical difference was found between the groups . CONCLUSIONS Dietary support , or control , maintained improvements in cardiovascular risk factors to the same extent and none of the interventions had a detrimental effect on bone CONTEXT Physical inactivity contributes to weight gain , but only 22 % of Americans are regularly active . OBJECTIVE To examine short- and long-term changes in weight , body composition , and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity . DESIGN Sixteen-week r and omized controlled trial with 1-year follow-up , conducted from August 1995 to December 1996 . PARTICIPANTS AND SETTING Forty obese women ( mean body mass index [ weight in kilograms divided by the square of height in meters ] , 32.9 kg/m2 ; mean weight , 89.2 kg ) with a mean age of 42.9 years ( range , 21 - 60 years ) seen in a university-based weight management program . INTERVENTIONS Structured aerobic exercise or moderate lifestyle activity ; low-fat diet of about 1200 kcal/d . MAIN OUTCOME MEASURES Changes in body weight , body composition , cardiovascular risk profiles , and physical fitness at 16 weeks and at 1 year . RESULTS Mean ( SD ) weight losses during the 16-week treatment program were 8.3 ( 3.8 ) kg for the aerobic group and 7.9 ( 4.2 ) kg for the lifestyle group ( within groups , P<.001 ; between groups , P = .08 ) . The aerobic group lost significantly less fat-free mass ( 0.5 [ 1.3 ] kg ) than the lifestyle group ( 1.4 [ 1.3 ] kg ; P = .03 ) . During the 1-year follow-up , the aerobic group regained 1.6 [ 5.5 ] kg , while the lifestyle group regained 0.08 ( 4.6 ) kg . At week 16 , serum triglyceride levels and total cholesterol levels were reduced significantly ( P<.001 ) from baseline ( 16.3 % and 10.1 % reductions , respectively ) but did not differ significantly between groups and were not different from baseline or between groups at week 68 . CONCLUSIONS A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women OBJECTIVE To compare changes in total and regional body composition using dual energy X-ray absorptiometry ( DEXA ) after subjects lost weight through change in diet or exercise .  DESIGN A 12-month , r and omized , controlled study of two weight-loss interventions -low-fat diet ad libitum or moderate , unsupervised exercise-in  free-living , middle-aged men . Compliance was determined at monthly measurement sessions through food records and activity logs ; DEXA scans were performed every 3 months . SUBJECTS/ SETTING Fifty-eight overweight men ( mean body mass index = 29.0 + /- 2.6 ; mean age = 43.4 + /- 5.7 years ) recruited from a national corporation were assigned r and omly to diet , exercise , or control groups . INTERVENTIONS One group reduced dietary fat to 26.4 % of energy intake but kept activity unchanged ; another group self-selected aerobic exercise ( three sessions per week at 65 % to 75 % maximum heart rate ) but kept diet unchanged . A control group maintained weight . MAIN OUTCOME MEASURES At 12 months , measurements of weight , total and regional fat mass and lean mass , energy intake , and percentage dietary fat ; physical activity indexes . STATISTICAL ANALYSES Results were analyzed using paired t tests and analysis of variance . RESULTS Mean weight loss was 6.4 + /- 3.3 kg in dieters and 2.6 + /- 3.0 kg in exercisers ; control subjects maintained weight . DEXA scans revealed that 40 % of dieters ' weight loss was lean tissue ; more than 80 % of weight lost by exercisers was fat . Exercisers maintained limb lean tissue and lost fat mass . CONCLUSIONS Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise . Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue OBJECTIVE The effects of three cognitive-behavioral weight control interventions for adults were compared : diet only , exercise only , and a combination of diet and exercise . This article reports 2-year follow-up data . DESIGN The three interventions were compared in a r and omized , experimental design . SUBJECTS A total of 127 men and women who were at least 14 kg overweight ( according to height-weight tables ) were recruited from an urban community and assigned r and omly to the experimental conditions . INTERVENTION The dietary intervention was a low-energy eating plan adjusted to produce a 1 kg/week loss of weight . The exercise component involved training in walking and a home-based program of up to five exercise periods per week . There were 12 weekly instructional sessions , followed by 3 biweekly and 8 monthly meetings . All sessions were led by registered dietitians . OUTCOME MEASURES Changes in body weight . STATISTICAL ANALYSES Analysis of variance for weight changes and repeated measures analysis of variance for weight change trends . RESULTS At 1 year , no significant differences were noted among the three groups . The diet-only group lost 6.8 kg , the exercise-only group lost 2.9 kg , and the combination group lost 8.9 kg ( P=.09 ) . During the second year , the diet-only group regained weight -- reaching 0.9 kg above baseline ; the combination group regained to 2.2 kg below baseline ; and the exercise-only group regained slightly to 2.7 kg below baseline ( P=.36 ) . Repeated measures analysis of variance showed a group-by-time interaction ( P=.001 ) ; data for the dieting groups best fit a U-shaped regain curve ( P=.001 ) . APPLICATIONS The results suggest that dieting is associated with weight loss followed by regain after treatment ends , whereas exercise alone produced smaller weight losses but better maintenance . The large outcome variability and unequal difficulty of the regimens across groups limit the generalizability of the findings IMPORTANCE Knee osteoarthritis ( OA ) , a common cause of chronic pain and disability , has biomechanical and inflammatory origins and is exacerbated by obesity . OBJECTIVE To determine whether a ≥10 % reduction in body weight induced by diet , with or without exercise , would improve mechanistic and clinical outcomes more than exercise alone . DESIGN , SETTING , AND PARTICIPANTS Single-blind , 18-month , r and omized clinical trial at Wake Forest University between July 2006 and April 2011 . The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program . Participants were 454 overweight and obese older community-dwelling adults ( age ≥55 years with body mass index of 27 - 41 ) with pain and radiographic knee OA . INTERVENTIONS Intensive diet-induced weight loss plus exercise , intensive diet-induced weight loss , or exercise . MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes : knee joint compressive force and plasma IL-6 levels ; secondary clinical outcomes : self-reported pain ( range , 0 - 20 ) , function ( range , 0 - 68 ) , mobility , and health-related quality of life ( range , 0 - 100 ) . RESULTS Three hundred ninety-nine participants ( 88 % ) completed the study . Mean weight loss for diet + exercise participants was 10.6 kg ( 11.4 % ) ; for the diet group , 8.9 kg ( 9.5 % ) ; and for the exercise group , 1.8 kg ( 2.0 % ) . After 18 months , knee compressive forces were lower in diet participants ( mean , 2487 N ; 95 % CI , 2393 to 2581 ) compared with exercise participants ( 2687 N ; 95 % CI , 2590 to 2784 , pairwise difference [Δ](exercise vs diet ) = 200 N ; 95 % CI , 55 to 345 ; P = .007 ) . Concentrations of IL-6 were lower in diet + exercise ( 2.7 pg/mL ; 95 % CI , 2.5 to 3.0 ) and diet participants ( 2.7 pg/mL ; 95 % CI , 2.4 to 3.0 ) compared with exercise participants ( 3.1 pg/mL ; 95 % CI , 2.9 to 3.4 ; Δ(exercise vs diet + exercise ) = 0.39 pg/mL ; 95 % CI , -0.03 to 0.81 ; P = .007 ; Δ(exercise vs diet ) = 0.43 pg/mL ; 95 % CI , 0.01 to 0.85 , P = .006 ) . The diet + exercise group had less pain ( 3.6 ; 95 % CI , 3.2 to 4.1 ) and better function ( 14.1 ; 95 % CI , 12.6 to 15.6 ) than both the diet group ( 4.8 ; 95 % CI , 4.3 to 5.2 ) and exercise group ( 4.7 ; 95 % CI , 4.2 to 5.1 , Δ(exercise vs diet + exercise ) = 1.02 ; 95 % CI , 0.33 to 1.71 ; P(pain ) = .004 ; 18.4 ; 95 % CI , 16.9 to 19.9 ; Δ(exercise vs diet + exercise ) , 4.29 ; 95 % CI , 2.07 to 6.50 ; P(function ) < .001 ) . The diet + exercise group ( 44.7 ; 95 % CI , 43.4 to 46.0 ) also had better physical health-related quality of life scores than the exercise group ( 41.9 ; 95 % CI , 40.5 to 43.2 ; Δ(exercise vs diet + exercise ) = -2.81 ; 95 % CI , -4.76 to -0.86 ; P = .005 ) . CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA , after 18 months , participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group ; those in the diet group had greater reductions in knee compressive force than those in the exercise group . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00381290
target: Results from the network meta-analyses confirmed these findings .
  Conclusions Moderate- quality evidence from the present network meta- analysis suggests that D + E can be highly recommended for long-term obesity management .
  Furthermore , the evidence suggests a moderate superiority of D over E with respect to anthropometric outcomes .
background: Background The aim of this meta- analysis was to compare the long-term efficacy of diet plus exercise ( D + E ) vs. diet ( D ) , D + E vs. exercise ( E ) and D vs. E on anthropometric outcomes and cardiovascular risk factors in overweight and obese participants .