Meta-analysis of different exercise protocols enhancing the effect of caloric restriction on weight loss_Chinese Journal of Evidence-Based Medicine

Authors：

PENG Tianhang , YAN Shuting , LIU Yiyi , YANG Juncho , ZHANG Chengnan ,  QIU Junqiang

Department of Sports Biochemistry, Beijing Sport University, Beijing 100084, P. R. China;

Corresponding?author：

QIU Junqiang, Email: qiujunqiang@bsu.edu.cn

Keywords：

Caloric restriction; Obesity; Overweight; Adults; Exercise intervention; Body composition

DOI：

10.7507/1672-2531.202501106

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the effects of different exercise interventions on weight management, body composition, metabolic health, and physical function in overweight or obese adults under caloric restriction. Methods A comprehensive search was conducted up to October 2024 in PubMed, Embase, Scopus, Web of Science, CNKI, and Cochrane Library databases. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. A meta-analysis was performed using RevMan 5.4 and Stata 14 software. Results A total of 60 randomized controlled trials (RCTs) involving 4 998 overweight/obese participants were included. The meta-analysis results indicated that, compared with the control group, aerobic exercise significantly reduced weight (MD=?3.94, 95%CI ?5.42 to ?2.46, P<0.05; BMI: MD=?1.32, 95%CI ?1.79 to ?0.84, P<0.05), and body fat percentage (MD =?1.41, 95%CI ?2.30 to ?0.52, P<0.05) in overweight/obese adults. For secondary outcomes, aerobic exercise significantly improved VO₂max and decreased total cholesterol (CHO) and low-density lipoprotein (LDL), while the combination of aerobic and resistance exercise significantly reduced triglycerides (TG) and insulin resistance index. Conclusion Exercise enhances weight loss, BMI reduction, body fat percentage reduction, and metabolic health improvement in conjunction with caloric restriction. Both aerobic and combined aerobic-resistance exercise interventions show beneficial multidimensional effects. However, some evidence remains uncertain, and future high-quality, long-term randomized controlled trials are needed to provide a solid foundation for personalized treatment plans.

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3.	Di Francesco A, Deighan AG, Litichevskiy L, et al. Dietary restriction impacts health and lifespan of genetically diverse mice. Nature, 2024, 634(8034): 684-692.
4.	Kahan S. Overweight and obesity management strategies. Am J Manag Care, 2016, 22(7 Suppl): s186-196.
5.	Koppold DA, Breinlinger C, Hanslian E, et al. International consensus on fasting terminology. Cell Metab, 2024, 36(8): 1779-1794.
6.	Heilbronn LK, Ravussin E. Calorie restriction and aging: review of the literature and implications for studies in humans. Am J Clin Nutr, 2003, 78(3): 361-369.
7.	Johnstone A. Fasting for weight loss: an effective strategy or latest dieting trend. Int J Obes (Lond), 2015, 39(5): 727-733.
8.	Vettor R, Di Vincenzo A, Maffei P, et al. Regulation of energy intake and mechanisms of metabolic adaptation or maladaptation after caloric restriction. Rev Endocr Metab Disord, 2020, 21(3): 399-409.
9.	Zhang Y, Liu C, Zhao Y, et al. The effects of calorie restriction in depression and potential mechanisms. Curr Neuropharmacol, 2015, 13(4): 536-542.
10.	Lang A, Froelicher ES. Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance. Eur J Cardiovasc Nurs, 2006, 5(2): 102-114.
11.	Beals JW, Kayser BD, Smith GI, et al. Dietary weight loss-induced improvements in metabolic function are enhanced by exercise in people with obesity and prediabetes. Nat Metab, 2023, 5(7): 1221-1235.
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14.	McGrath C, Sankaran JS, Misaghian-Xanthos N, et al. Exercise degrades bone in caloric restriction, despite suppression of marrow adipose tissue (MAT). J Bone Miner Res, 2020, 35(1): 106-115.
15.	Brinkley TE, Leng I, Bailey MJ, et al. Effects of exercise and weight loss on proximal aortic stiffness in older adults with obesity. Circulation, 2021, 144(9): 684-693.
16.	Recchia F, Leung CK, Yu AP, et al. Dose-response effects of exercise and caloric restriction on visceral adiposity in overweight and obese adults: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med, 2023, 57(16): 1035-1041.
17.	Abe T, Song JS, Bell ZW, et al. Comparisons of calorie restriction and structured exercise on reductions in visceral and abdominal subcutaneous adipose tissue: a systematic review. Eur J Clin Nutr, 2022, 76(2): 184-195.
18.	Khalafi M, Malandish A, Rosenkranz SK, et al. Effect of resistance training with and without caloric restriction on visceral fat: a systemic review and meta-analysis. Obes Rev, 2021, 22(9): e13275.
19.	Verheggen RJ, Maessen MF, Green DJ, et al. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev, 2016, 17(8): 664-690.
20.	李佩遠, 楊俊超, 盧智慧, 等. HIIT對超重/肥胖人群減重及血脂代謝影響的Meta分析. 中國循證醫學雜志, 2024, 24(3): 272-279.
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22.	Khalafi M, Symonds ME, Akbari A. The impact of exercise training versus caloric restriction on inflammation markers: a systemic review and meta-analysis. Crit Rev Food Sci Nutr, 2022, 62(15): 4226-4241.
23.	Guo Z, Cai J, Wu Z, et al. Effect of high-intensity interval training combined with fasting in the treatment of overweight and obese adults: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(8): 4638.
24.	Sardeli AV, Komatsu TR, Mori MA, et al. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients, 2018, 10(4): 423.
25.	Booth A, Clarke M, Ghersi D, et al. An international registry of systematic-review protocols. Lancet, 2011, 377(9760): 108-109.
26.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
27.	Higgins JPT, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
28.	Armstrong R, Waters E, Doyle J. Reviews in public health and health promotion. In: Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, Ltd: 2008, 593-606.
29.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
30.	Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011, 43(7): 1334-1359.
31.	Borenstein M, Hedges LV, Higgins JPT, et al. Introduction to meta-analysis. John Wiley & Sons, 2021.
32.	Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis, 2014, 56(4): 441-447.
33.	Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord, 1997, 21(10): 941-947.
34.	Chang YH, Yang HY, Shun SC. Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes, 2021, 45(5): 982-997.
35.	Lee DC, Brellenthin AG, Lanningham-Foster LM, et al. Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial. Eur Heart J, 2024, 45(13): 1127-1142.
36.	孫宇欣, 郭曉湲, 陳適, 等. 以抗阻運動為主的運動處方對超重和肥胖成年人群糖脂代謝影響的Meta分析. 協和醫學雜志, 2025, 16(1): 235-247.
37.	Landgraf RR, Goswami D, Rajamohan F, et al. Activation of AMP-activated protein kinase revealed by hydrogen/deuterium exchange mass spectrometry. Structure, 2013, 21(11): 1942-1953.
38.	Afinanisa Q, Cho MK, Seong HA. AMPK localization: a key to differential energy regulation. Int J Mol Sci, 2021, 22(20): 10921.
39.	Stine JG, Hummer B, Smith N, et al. AMPED study: Protocol for a randomized controlled trial of different doses of aerobic exercise training. Hepatol Commun, 2024, 8(7): e0464.
40.	Richter EA, Ruderman NB. AMPK and the biochemistry of exercise: implications for human health and disease. Biochem J, 2009, 418(2): 261-275.
41.	Ruderman NB, Park H, Kaushik VK, et al. AMPK as a metabolic switch in rat muscle, liver and adipose tissue after exercise. Acta Physiol Scand, 2003, 178(4): 435-442.
42.	Winder WW, Hardie DG. Inactivation of acetyl-CoA carboxylase and activation of AMP-activated protein kinase in muscle during exercise. Am J Physiol. 1996, 270(2 Pt 1): E299-E304.
43.	Witczak CA, Sharoff CG, Goodyear LJ. AMP-activated protein kinase in skeletal muscle: from structure and localization to its role as a master regulator of cellular metabolism. Cell Mol Life Sci, 2008, 65(23): 3737-3755.
44.	Muise ES, Guan HP, Liu J, et al. Pharmacological AMPK activation induces transcriptional responses congruent to exercise in skeletal and cardiac muscle, adipose tissues and liver. PLoS One, 2019, 14(2): e0211568.
45.	Ruderman NB, Saha AK, Kraegen EW. Minireview: malonyl CoA, AMP-activated protein kinase, and adiposity. Endocrinology, 2003, 144(12): 5166-5171.
46.	Dreyer HC, Drummond MJ, Pennings B, et al. Leucine-enriched essential amino acid and carbohydrate ingestion following resistance exercise enhances mTOR signaling and protein synthesis in human muscle. Am J Physiol Endocrinol Metab, 2008, 294(2): E392-400.
47.	Takegaki J, Ogasawara R, Tamura Y, et al. Repeated bouts of resistance exercise with short recovery periods activates mTOR signaling, but not protein synthesis, in mouse skeletal muscle. Physiol Rep, 2017, 5(22): e13515.
48.	Sadria M, Layton AT. Interactions among mTORC, AMPK and SIRT: a computational model for cell energy balance and metabolism. Cell Commun Signal, 2021, 19(1): 57.
49.	Appuhamy JADR N, Kebreab E, Simon M, et al. Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials. Diabetol Metab Syndr, 2014, 6: 127.
50.	Azar KM, Xiao L, Ma J. Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care. Biomed Res Int, 2013, 2013: 191209.
51.	García-Hermoso A, Izquierdo M, Alonso-Martínez AM, et al. Association between exercise-induced changes in cardiorespiratory fitness and adiposity among overweight and obese youth: a meta-analysis and meta-regression analysis. Children (Basel), 2020, 7(9): 147.
52.	Hernández-Reyes A, Cámara-Martos F, Molina-Luque R, et al. Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial. BMC Womens Health, 2019, 19(1): 167.
53.	Carter RA, McCutcheon LJ, Valle E, et al. Effects of exercise training on adiposity, insulin sensitivity, and plasma hormone and lipid concentrations in overweight or obese, insulin-resistant horses. Am J Vet Res, 2010, 71(3): 314-321.
54.	Huang G, Wang R, Chen P, et al. Dose-response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol, 2016, 23(5): 518-529.
55.	Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc, 2011, 43(2): 249.
56.	Huang G, Gibson CA, Tran ZV, et al. Controlled endurance exercise training and VO2max changes in older adults: a meta-analysis. Prev Cardiol, 2005, 8(4): 217-225.
57.	Chomiuk T, Folga A, Mamcarz A. The influence of systematic pulse-limited physical exercise on the parameters of the cardiovascular system in patients over 65 years of age. Arch Med Sci, 2013, 9(2): 201-209.
58.	Kohrt WM, Malley MT, Coggan AR, et al. Effects of gender, age, and fitness level on response of VO2max to training in 60-71 yr olds. J Appl Physiol, 1991, 71(5): 2004-2011.
59.	Dorhout BG, Doets EL, van Dongen EJI, et al. In-depth analyses of the effects of a diet and resistance exercise intervention in older adults: who benefits most from promuscle in practice. J Gerontol A Biol Sci Med Sci, 2021, 76(12): 2204-2212.
60.	Ostrowski L, Speiser PW, Accacha S, et al. Demographics and anthropometrics impact benefits of health intervention: data from the reduce obesity and diabetes project. Obes Sci Pract, 2019, 5(1): 46-58.
61.	O'Gorman SA, Miller CT, Rawstorn JC, et al. Sex differences in the feasibility of aerobic exercise training for improving cardiometabolic health outcomes in adults with type 2 diabetes. J Clin Med, 2023, 12(4): 1255.
62.	Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA, 2018, 320(19): 2020-2028.
63.	WHO. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization, 2020.

1. World Obesity Federation. Economic impact of overweight and obesity to surpass $4 trillion by 2035. 2023.
2. Huang J, Li Y, Chen M, et al. Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act, 2024, 21(1): 108.
3. Di Francesco A, Deighan AG, Litichevskiy L, et al. Dietary restriction impacts health and lifespan of genetically diverse mice. Nature, 2024, 634(8034): 684-692.
4. Kahan S. Overweight and obesity management strategies. Am J Manag Care, 2016, 22(7 Suppl): s186-196.
5. Koppold DA, Breinlinger C, Hanslian E, et al. International consensus on fasting terminology. Cell Metab, 2024, 36(8): 1779-1794.
6. Heilbronn LK, Ravussin E. Calorie restriction and aging: review of the literature and implications for studies in humans. Am J Clin Nutr, 2003, 78(3): 361-369.
7. Johnstone A. Fasting for weight loss: an effective strategy or latest dieting trend. Int J Obes (Lond), 2015, 39(5): 727-733.
8. Vettor R, Di Vincenzo A, Maffei P, et al. Regulation of energy intake and mechanisms of metabolic adaptation or maladaptation after caloric restriction. Rev Endocr Metab Disord, 2020, 21(3): 399-409.
9. Zhang Y, Liu C, Zhao Y, et al. The effects of calorie restriction in depression and potential mechanisms. Curr Neuropharmacol, 2015, 13(4): 536-542.
10. Lang A, Froelicher ES. Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance. Eur J Cardiovasc Nurs, 2006, 5(2): 102-114.
11. Beals JW, Kayser BD, Smith GI, et al. Dietary weight loss-induced improvements in metabolic function are enhanced by exercise in people with obesity and prediabetes. Nat Metab, 2023, 5(7): 1221-1235.
12. ?libinait? L, Solianik R, Vizbarait? D, et al. The effect of combined aerobic exercise and calorie restriction on mood, cognition, and motor behavior in overweight and obese women. J Phys Act Health, 2020, 17(2): 204-210.
13. Thomas TR, Warner SO, Dellsperger KC, et al. Exercise and the metabolic syndrome with weight regain. J Appl Physiol, 2010, 109(1): 3-10.
14. McGrath C, Sankaran JS, Misaghian-Xanthos N, et al. Exercise degrades bone in caloric restriction, despite suppression of marrow adipose tissue (MAT). J Bone Miner Res, 2020, 35(1): 106-115.
15. Brinkley TE, Leng I, Bailey MJ, et al. Effects of exercise and weight loss on proximal aortic stiffness in older adults with obesity. Circulation, 2021, 144(9): 684-693.
16. Recchia F, Leung CK, Yu AP, et al. Dose-response effects of exercise and caloric restriction on visceral adiposity in overweight and obese adults: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med, 2023, 57(16): 1035-1041.
17. Abe T, Song JS, Bell ZW, et al. Comparisons of calorie restriction and structured exercise on reductions in visceral and abdominal subcutaneous adipose tissue: a systematic review. Eur J Clin Nutr, 2022, 76(2): 184-195.
18. Khalafi M, Malandish A, Rosenkranz SK, et al. Effect of resistance training with and without caloric restriction on visceral fat: a systemic review and meta-analysis. Obes Rev, 2021, 22(9): e13275.
19. Verheggen RJ, Maessen MF, Green DJ, et al. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev, 2016, 17(8): 664-690.
20. 李佩遠, 楊俊超, 盧智慧, 等. HIIT對超重/肥胖人群減重及血脂代謝影響的Meta分析. 中國循證醫學雜志, 2024, 24(3): 272-279.
21. Keenan S, Cooke MB, Chen WS, et al. The effects of intermittent fasting and continuous energy restriction with exercise on cardiometabolic biomarkers, dietary compliance, and perceived hunger and mood: secondary outcomes of a randomised, controlled trial. Nutrients, 2022, 14(15): 3071.
22. Khalafi M, Symonds ME, Akbari A. The impact of exercise training versus caloric restriction on inflammation markers: a systemic review and meta-analysis. Crit Rev Food Sci Nutr, 2022, 62(15): 4226-4241.
23. Guo Z, Cai J, Wu Z, et al. Effect of high-intensity interval training combined with fasting in the treatment of overweight and obese adults: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(8): 4638.
24. Sardeli AV, Komatsu TR, Mori MA, et al. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients, 2018, 10(4): 423.
25. Booth A, Clarke M, Ghersi D, et al. An international registry of systematic-review protocols. Lancet, 2011, 377(9760): 108-109.
26. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
27. Higgins JPT, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
28. Armstrong R, Waters E, Doyle J. Reviews in public health and health promotion. In: Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, Ltd: 2008, 593-606.
29. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
30. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011, 43(7): 1334-1359.
31. Borenstein M, Hedges LV, Higgins JPT, et al. Introduction to meta-analysis. John Wiley & Sons, 2021.
32. Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis, 2014, 56(4): 441-447.
33. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord, 1997, 21(10): 941-947.
34. Chang YH, Yang HY, Shun SC. Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes, 2021, 45(5): 982-997.
35. Lee DC, Brellenthin AG, Lanningham-Foster LM, et al. Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial. Eur Heart J, 2024, 45(13): 1127-1142.
36. 孫宇欣, 郭曉湲, 陳適, 等. 以抗阻運動為主的運動處方對超重和肥胖成年人群糖脂代謝影響的Meta分析. 協和醫學雜志, 2025, 16(1): 235-247.
37. Landgraf RR, Goswami D, Rajamohan F, et al. Activation of AMP-activated protein kinase revealed by hydrogen/deuterium exchange mass spectrometry. Structure, 2013, 21(11): 1942-1953.
38. Afinanisa Q, Cho MK, Seong HA. AMPK localization: a key to differential energy regulation. Int J Mol Sci, 2021, 22(20): 10921.
39. Stine JG, Hummer B, Smith N, et al. AMPED study: Protocol for a randomized controlled trial of different doses of aerobic exercise training. Hepatol Commun, 2024, 8(7): e0464.
40. Richter EA, Ruderman NB. AMPK and the biochemistry of exercise: implications for human health and disease. Biochem J, 2009, 418(2): 261-275.
41. Ruderman NB, Park H, Kaushik VK, et al. AMPK as a metabolic switch in rat muscle, liver and adipose tissue after exercise. Acta Physiol Scand, 2003, 178(4): 435-442.
42. Winder WW, Hardie DG. Inactivation of acetyl-CoA carboxylase and activation of AMP-activated protein kinase in muscle during exercise. Am J Physiol. 1996, 270(2 Pt 1): E299-E304.
43. Witczak CA, Sharoff CG, Goodyear LJ. AMP-activated protein kinase in skeletal muscle: from structure and localization to its role as a master regulator of cellular metabolism. Cell Mol Life Sci, 2008, 65(23): 3737-3755.
44. Muise ES, Guan HP, Liu J, et al. Pharmacological AMPK activation induces transcriptional responses congruent to exercise in skeletal and cardiac muscle, adipose tissues and liver. PLoS One, 2019, 14(2): e0211568.
45. Ruderman NB, Saha AK, Kraegen EW. Minireview: malonyl CoA, AMP-activated protein kinase, and adiposity. Endocrinology, 2003, 144(12): 5166-5171.
46. Dreyer HC, Drummond MJ, Pennings B, et al. Leucine-enriched essential amino acid and carbohydrate ingestion following resistance exercise enhances mTOR signaling and protein synthesis in human muscle. Am J Physiol Endocrinol Metab, 2008, 294(2): E392-400.
47. Takegaki J, Ogasawara R, Tamura Y, et al. Repeated bouts of resistance exercise with short recovery periods activates mTOR signaling, but not protein synthesis, in mouse skeletal muscle. Physiol Rep, 2017, 5(22): e13515.
48. Sadria M, Layton AT. Interactions among mTORC, AMPK and SIRT: a computational model for cell energy balance and metabolism. Cell Commun Signal, 2021, 19(1): 57.
49. Appuhamy JADR N, Kebreab E, Simon M, et al. Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials. Diabetol Metab Syndr, 2014, 6: 127.
50. Azar KM, Xiao L, Ma J. Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care. Biomed Res Int, 2013, 2013: 191209.
51. García-Hermoso A, Izquierdo M, Alonso-Martínez AM, et al. Association between exercise-induced changes in cardiorespiratory fitness and adiposity among overweight and obese youth: a meta-analysis and meta-regression analysis. Children (Basel), 2020, 7(9): 147.
52. Hernández-Reyes A, Cámara-Martos F, Molina-Luque R, et al. Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial. BMC Womens Health, 2019, 19(1): 167.
53. Carter RA, McCutcheon LJ, Valle E, et al. Effects of exercise training on adiposity, insulin sensitivity, and plasma hormone and lipid concentrations in overweight or obese, insulin-resistant horses. Am J Vet Res, 2010, 71(3): 314-321.
54. Huang G, Wang R, Chen P, et al. Dose-response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol, 2016, 23(5): 518-529.
55. Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc, 2011, 43(2): 249.
56. Huang G, Gibson CA, Tran ZV, et al. Controlled endurance exercise training and VO2max changes in older adults: a meta-analysis. Prev Cardiol, 2005, 8(4): 217-225.
57. Chomiuk T, Folga A, Mamcarz A. The influence of systematic pulse-limited physical exercise on the parameters of the cardiovascular system in patients over 65 years of age. Arch Med Sci, 2013, 9(2): 201-209.
58. Kohrt WM, Malley MT, Coggan AR, et al. Effects of gender, age, and fitness level on response of VO2max to training in 60-71 yr olds. J Appl Physiol, 1991, 71(5): 2004-2011.
59. Dorhout BG, Doets EL, van Dongen EJI, et al. In-depth analyses of the effects of a diet and resistance exercise intervention in older adults: who benefits most from promuscle in practice. J Gerontol A Biol Sci Med Sci, 2021, 76(12): 2204-2212.
60. Ostrowski L, Speiser PW, Accacha S, et al. Demographics and anthropometrics impact benefits of health intervention: data from the reduce obesity and diabetes project. Obes Sci Pract, 2019, 5(1): 46-58.
61. O'Gorman SA, Miller CT, Rawstorn JC, et al. Sex differences in the feasibility of aerobic exercise training for improving cardiometabolic health outcomes in adults with type 2 diabetes. J Clin Med, 2023, 12(4): 1255.
62. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA, 2018, 320(19): 2020-2028.
63. WHO. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization, 2020.

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