Effect of exercise on cardiometabolic health of adults with overweight or obesity: Focus on blood pressure, insulin resistance, and intrahepatic fat-A systematic review and meta-analysis

Abstract

This systematic review examined the impact of exercise intervention programs on selected cardiometabolic health indicators in adults with overweight or obesity. Three electronic databases were explored for randomized controlled trials (RCTs) that included adults with overweight or obesity and provided exercise-training interventions. Effects on blood pressure, insulin resistance (homeostasis model of insulin resistance, HOMA-IR), and magnetic resonance measures of intrahepatic fat in exercise versus control groups were analyzed using random effects meta-analyses. Fifty-four articles matched inclusion criteria. Exercise training reduced systolic and diastolic blood pressure (mean difference, MD = -2.95 mmHg [95% CI -4.22, -1.68], p < 0.00001, I² = 63% and MD = -1.93 mmHg [95% CI -2.73, -1.13], p < 0.00001, I² = 54%, 60 and 58 study arms, respectively). Systolic and diastolic blood pressure decreased also when considering only subjects with hypertension. Exercise training significantly decreased HOMA-IR (standardized mean difference, SMD = -0.34 [-0.49, -0.18], p < 0.0001, I² = 48%, 37 study arms), with higher effect size in subgroup of patients with type 2 diabetes (SMD = -0.50 [95% CI: -0.83, -0.17], p = 0.003, I² = 39%). Intrahepatic fat decreased significantly after exercise interventions (SMD = -0.59 [95% CI: -0.78, -0.41], p < 0.00001, I² = 0%), with a larger effect size after high-intensity interval training. In conclusion, exercise training is effective in improving cardiometabolic health in adults with overweight or obesity also when living with comorbitidies.

Keywords: NAFLD; hypertension; insulin resistance; morbid obesity; physical activity; type 2 diabetes.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) flow diagram

FIGURE 2

Forest plot of the effect of exercise training versus control on systolic blood pressure in adults with overweight or obesity, grouped by presence/absence of arterial hypertension. Presents mean difference between subjects participating in exercise training versus control in change of systolic blood pressure. Subgroup “Normotensive patients” includes randomized controlled trials (RCTs) that excluded patients with overweight or obesity and hypertension. Subgroup “Pre‐hypertension or hypertension” includes RCTs that included only patients with overweight or obesity and prehypertension or hypertension. Articles are presented in alphabetical order. Abdelaal 2014 (a): aerobic exercise; Abdelaal 2014 (b): resistance exercise. Fenkci (a): aerobic training; Fenkci (b): resistance training. Figueroa 2015 (a): high ankle blood pressure; Figueroa 2015 (b): low ankle blood pressure. Gorostegi‐Anduaga 2018 (a): high volume‐moderate intensity continuous training; Gorostegi‐Anduaga 2018 (b): high volume‐high intensity interval training; Gorostegi‐Anduaga 2018 (c): low volume‐high intensity interval training. Meckling (a): control diet + exercise versus control diet; Meckling (b): high protein diet + exercise versus high‐protein diet. Mohr 2014 (a): moderate intensity continuous training versus control. Mohr 2014 (b): high intensity interval training versus control. Schroeder 2018 (a): aerobic exercise; Schroeder 2018 (b): resistance exercise; Schroeder 2018 (c): combined exercise. Swift 2012 (a): lower energy expenditure (8 kcal/kg/week); Swift 2012 (b): higher energy expenditure (12 kcal/kg/week)

FIGURE 3

Forest plot of the effect of exercise training versus control on diastolic blood pressure in adults with overweight or obesity, grouped by presence/absence of arterial hypertension. Presents mean difference between subjects participating in exercise training versus control in change of diastolic blood pressure. Articles are presented in alphabetical order. Subgroup “Normotensive patients” includes randomized controlled trials (RCTs) that excluded patients with overweight or obesity and hypertension. Subgroup “Pre‐hypertension or hypertension” includes RCTs that included only patients with overweight or obesity and prehypertension or hypertension. Abdelaal 2014 (a): Aerobic exercise; Abdelaal 2014 (b): resistance exercise. Fenkci (a): aerobic training; Fenkci (b): resistance training; Gorostegi‐Anduaga 2018 (a): high volume‐moderate intensity continuous training; Gorostegi‐Anduaga 2018 (b): high volume‐high intensity interval training; Gorostegi‐Anduaga 2018 (c): low volume‐high intensity interval training. Meckling (a): control diet + exercise versus control diet; Meckling (b): high protein diet + exercise versus high protein diet. Mohr 2014 (a): moderate intensity continuous training versus control; Mohr 2014 (b): high intensity interval training versus control. Schroeder 2018 (a): aerobic exercise; Schroeder 2018 (b): resistance exercise; Schroeder 2018 (c): combined exercise. Swift 2012 (a): higher energy expenditure (12 kcal/kg/week); Swift 2012 (b): lower energy expenditure (8 kcal/kg/week)

FIGURE 4

Forest plot of the effect of exercise training versus control on Homeostasis Model Assessment Insulin Resistance Index (HOMA‐IR) in adults with overweight or obesity, grouped by presence/absence type 2 diabetes. Presents mean difference between subjects participating in exercise training versus control in change of HOMA‐IR. Articles are presented in alphabetical order. Subgroup “No type 2 diabetes” includes randomized controlled trials (RCTs) that excluded patients with overweight or obesity and type 2 diabetes. Subgroup “Type 2 diabetes” includes RCTs that included only patients with overweight or obesity and type 2 diabetes. Articles are presented in alphabetical order. Bouchonville 2014 (a): exercise versus control. Bouchonville 2014 (b):diet + exercise versus diet; Fenkci (a): aerobic training; Fenkci (b): resistance training. Fritz 2012 (a): normal glucose tolerance; Fritz 2012 (b): impaired glucose tolerance; Fritz 2012 (c): type 2 diabetes. Kadoglou 2010 (a): exercise versus control; Kadoglou 2010 (b): rosiglitazone + exercise versus rosiglitazone. Oh 2018 (a): diet + exercise versus diet; Oh 2018 (b): exercise versus control; Winding 2014 (a): endurance training; Winding 2014 (b): high intensity interval training

FIGURE 5

Pooled analysis for the effect of exercise training versus control on intrahepatic fat in adults with overweight or obesity, grouped by exercise modality. Presents mean difference between subjects participating in exercise training versus control in change of intrahepatic fat. Articles are presented in alphabetical order. Keating 2015 (a): high intensity, low volume aerobic exercise; Keating 2015 (b): low intensity, high volume aerobic exercise. Keating 2015 (c): low intensity, low volume aerobic exercise. Winn 2017 (a): high intensity interval training; Winn 2017 (b): moderate intensity continuous training; Zhang 2016 (a): moderate intensity training; Zhang (b): vigorous intensity training