Dose-dependent associations of joint aerobic and muscle-strengthening exercise with obesity: A cross-sectional study of 280,605 adults

Abstract

Background: Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone, a combination of moderate-to-vigorous physical activity (MVPA: brisk walking/jogging, cycling) and muscle-strengthening exercise (MSE: push-ups/sit-ups, using weight machines) has more favorable associations with optimal weight status. However, few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.

Methods: Based on cross-sectional analyses of the European Health Interview Survey Wave 2 (2013-2014), we examined prevalence ratios (PRs) of joint and stratified associations between MVPA (4 categories: (i) 0 min/week, (ii) 1-149 min/week, (iii) 150-299 min/week, and (iv) ≥300 min/week) and MSE (3 categories: (i) 0 day/week, (ii) 1 day/week, and (iii) ≥2 days/week) with body mass index-defined obesity (body mass index of ≥30.0 kg/m²) using Poisson regression with robust error variance. PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics (e.g., sex, age, education, income, and smoking status).

Results: Data were available for 280,456 adults (≥18 years), of which 46,166 (15.5%) were obese. The interaction MVPA × MSE guideline adherence was statistically significant for obesity (p ≤ 0.05). The joint MVPA-MSE analysis showed that compared to the reference group (i.e., no MVPA and no MSE), the PRs followed a dose-dependent pattern, with the lowest observed among those reporting ≥150 MVPA min/week and ≥1 MSE days/week (PR: 0.43; 95% confidence interval: 0.41-0.46). When stratified across each MVPA strata, the PRs were mostly lower among those engaging in MSE 1 day/week, as compared to those doing MSE ≥2 days/week.

Conclusion: There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity. Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

Keywords: Body mass index; Epidemiology; Public health; Resistance exercise.

Graphical abstract

Fig. 1

European Health Interview Survey (EHIS Wave 2) participant flow diagram.

Fig. 2

The stratified association between aerobic MVPA and MSE and body mass index-derived obesity. Obesity classified as body mass index of ≥30.0 kg/m². ^a Prevalence ratio calculated using a Poisson regression model with a robust error variance and adjusted sex, age, education, income, occupational status, degree of urbanization, country, physical effort during working tasks, self-rated health, limitations owing to health problems for ≥6 months, and smoking (raw data shown in Supplementary Table 3). 95%CI =  95% confidence interval; MSE = muscle-strengthening exercise; MVPA = moderate-to-vigorous physical activity; ref = 0 min/week .

Fig. 3

The joint associations between aerobic MVPA and MSE and body mass index-derived obesity. Obesity classified as body mass index of ≥30.0 kg/m². ^a Prevalence ratio calculated using a Poisson regression model with a robust error variance and adjusted sex, age, education, income, occupational status, degree of urbanization, country, physical effort during working tasks, self-rated health, limitations due to health problems for ≥6 months, and smoking (raw data shown in Supplementary Table 4). 95%CI = 95% confidence interval; MSE = muscle-strengthening exercise; MVPA = moderate-to-vigorous physical activity; ref = 0 min/week.