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Clinician Article

Exercise for overweight or obesity.



  • Shaw K
  • Gennat H
  • O'Rourke P
  • Del Mar C
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003817. doi: 10.1002/14651858.CD003817.pub3. (Review)
PMID: 17054187
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Disciplines
  • Special Interest - Obesity -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 4/7

Abstract

BACKGROUND: Clinical trials have shown that exercise in adults with overweight or obesity can reduce bodyweight. There has been no quantitative systematic review of this in The Cochrane Library.

OBJECTIVES: To assess exercise as a means of achieving weight loss in people with overweight or obesity, using randomised controlled clinical trials.

SEARCH STRATEGY: Studies were obtained from computerised searches of multiple electronic bibliographic databases. The last search was conducted in January 2006.

SELECTION CRITERIA: Studies were included if they were randomised controlled trials that examined body weight change using one or more physical activity intervention in adults with overweight or obesity at baseline and loss to follow-up of participants of less than 15%.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data.

MAIN RESULTS: The 43 studies included 3476 participants. Although significant heterogeneity in some of the main effects' analyses limited ability to pool effect sizes across some studies, a number of pooled effect sizes were calculated. When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone (WMD -1.1 kg; 95% confidence interval (CI) -1.5 to -0.6). Increasing exercise intensity increased the magnitude of weight loss (WMD -1.5 kg; 95% CI -2.3 to -0.7). There were significant differences in other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Exercise as a sole weight loss intervention resulted in significant reductions in diastolic blood pressure (WMD -2 mmHg; 95% CI -4 to -1), triglycerides (WMD -0.2 mmol/L; 95% CI -0.3 to -0.1) and fasting glucose (WMD -0.2 mmol/L; 95% CI -0.3 to -0.1). Higher intensity exercise resulted in greater reduction in fasting serum glucose than lower intensity exercise (WMD -0.3 mmol/L; 95% CI -0.5 to -0.2). No data were identified on adverse events, quality of life, morbidity, costs or on mortality.

AUTHORS' CONCLUSIONS: The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.


Clinical Comments

Internal Medicine

Well done systematic review on the impact of exercise on weight management. Would recommend for abstraction.

Special Interest - Obesity -- Physician

The paper gives a comprehensive analysis of the effects of exercise on weight loss, based on RCT fulfilling strict criteria. It indicates a relative dearth of good studies, and particularly of long-term studies or follow-up of a reasonable length to be of clinical significance. The most impressive sentence is the one at page 6, dealing with primary outcomes, and pointing to the limits of previous studies: “No data were identified on mortality, morbidity, adverse events or quality of life among the trials included in this review”. The study does not change clinical practice, but simply reinforces the idea that behavior therapy aimed at lifestyle changes should always include both physical exercise and food restriction. Although this is common practice, and most obesity centers claim to move along these lines, in practice physical exercise remains frequently neglected.

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