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Does exercise training augment improvements in quality of life induced by energy restriction for obese populations? A systematic review

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Abstract

Objective

Obesity is associated with a decline in health-related quality of life (HRQOL), while weight loss and exercise training have a positive influence. The aim of this systematic review was to compare the effects of energy restriction (ER) alone intervention to diet and exercise intervention on HRQOL.

Methods

MEDLINE, CINAHL and PsycINFO databases were searched for randomised controlled trials examining HRQOL through lifestyle interventions which examined ER and energy restriction plus exercise in obese adults.

Results

Nine hundred and fifty-two papers were assessed for inclusion in this review with nine being deemed suitable. This review indicates that four studies provide evidence to support the role of exercise in addition to ER to improve HRQOL in adults with obesity. The findings of this review are limited due to the limited number of studies as well as substantial heterogeneity in ER, exercise prescription variables and outcome measures utilised within studies.

Conclusions

A definitive conclusion regarding the capacity of exercise to facilitate greater improvement in HRQOL than diet alone, or, to formulate an exercise prescription for obese adults to address HRQOL is not feasible based on the existing evidence. Future studies should utilise comparable HRQOL assessment tools along with ensuring full reporting of results.

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Abbreviations

AQLQ:

Asthma quality of life questionnaire

BMI:

Body mass index

ER:

Energy restriction

EREX:

Energy restriction plus exercise

ERAEX:

Energy restriction plus aerobic exercise

ERAREX:

Energy restriction plus aerobic and resistance exercise

GWBS:

General well-being schedule

HADS:

Hospital Anxiety Depression Scale

HRQOL:

Health-related quality of life

IWQOL:

Impact of weight on quality of life questionnaire

MFI-20:

Multi-dimensional fatigue inventory

MHR:

Maximum heart rate

PA:

Physical activity

PCOSQ:

Polycystic ovarian syndrome questionnaire

PICOS:

Participants, intervention, comparators, outcomes and study design

RM:

Repetition maximum

RCT:

Randomised controlled trial

SF-36:

Medical outcomes short form health survey

References

  1. WHO. (2014). World health statistics 2014. Copenhagen: World Health Organisation.

    Google Scholar 

  2. NCD Risk Factor Collaboration. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet, 387(10026), 1377–1396.

    Article  Google Scholar 

  3. Guh, D. P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C. L., & Anis, A. H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC public health, 9(1), 88.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bogers, R. P., Bemelmans, W. E., Hoogenveen, R. T., et al. (2007). Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: A meta-analysis of 21 cohort studies including more than 300 000 persons. Archives of Internal Medicine, 167(16), 1720–1728.

    Article  PubMed  Google Scholar 

  5. Renehan, A. G., Tyson, M., Egger, M., Heller, R. F., & Zwahlen, M. (2008). Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. The Lancet, 371(9612), 569–578.

    Article  Google Scholar 

  6. Colagiuri, S., Lee, C. M., Colagiuri, R., Magliano, D., Shaw, J. E., Zimmet, P. Z., et al. (2010). The cost of overweight and obesity in Australia. Medical Journal of Australia, 192(5), 260–264.

    PubMed  Google Scholar 

  7. Strazzullo, P., D’Elia, L., Cairella, G., Garbagnati, F., Cappuccio, F. P., & Scalfi, L. (2010). Excess body weight and incidence of stroke: Meta-analysis of prospective studies with 2 million participants. Stroke, 41(5), e418–e426.

    Article  PubMed  Google Scholar 

  8. Eeg-Olofsson, K., Cederholm, J., Nilsson, P., Zethelius, B., Nunez, L., Gudbjörnsdóttir, S., et al. (2009). Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: An observational study in 13,087 patients. Diabetologia, 52(1), 65–73.

    Article  CAS  PubMed  Google Scholar 

  9. WHO. (2000). Obesity: Preventing and managing the global epidemic. Geneva: Report of a WHO Consultation.

    Google Scholar 

  10. Puhl, R., & Brownell, K. D. (2003). Ways of coping with obesity stigma: Review and conceptual analysis. Eating Behaviors, 4(1), 53–78.

    Article  PubMed  Google Scholar 

  11. Kolotkin, R. L., Crosby, R. D., & Williams, G. R. (2002). Health-related quality of life varies among obese subgroups. Obesity Research, 10(8), 748–756.

    Article  PubMed  Google Scholar 

  12. Maruish, M. (Ed.). (2011). User’s manual for the SF-36v2 health survey, third edition (3rd ed.). Lincoln, RI: QualityMetric Incorporated.

    Google Scholar 

  13. Ware, J., Kosinski, M., & Keller, S. (1998). SF-12: How to score the SF-12 physical and mental health summary scales.

  14. Ware, J. E., Jr. (2000). SF-36 health survey update. Spine, 25(24), 3130–3139.

    Article  PubMed  Google Scholar 

  15. Dixon, J. B., Dixon, M. E., & O’Brien, P. E. (2001). Quality of life after lap-band placement: Influence of time, weight loss, and comorbidities. Obesity Research, 9(11), 713–721.

    Article  CAS  PubMed  Google Scholar 

  16. Bray, G. A. (2008). Lifestyle and pharmacological approaches to weight loss: Efficacy and safety. The Journal of Clinical Endocrinology & Metabolism, 93(11_supplement_1), s81–s88.

  17. O’Brien, P. E., Brown, W. A., & Dixon, J. B. (2005). Obesity, weight loss and bariatric surgery. Medical Journal of Australia, 183(6), 310.

    PubMed  Google Scholar 

  18. O’Brien, P. E., Dixon, J. B., Laurie, C., Skinner, S., Proietto, J., McNeil, J., et al. (2006). Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: A randomized trial. Annals of Internal Medicine, 144(9), 625–633.

    Article  PubMed  Google Scholar 

  19. Martins, C., Strømmen, M., Stavne, O. A., Nossum, R., Mårvik, R., & Kulseng, B. (2011). Bariatric surgery versus lifestyle interventions for morbid obesity—Changes in body weight, risk factors and comorbidities at 1 year. Obesity Surgery, 21(7), 841–849.

    Article  PubMed  Google Scholar 

  20. Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. NHMRC. (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In D. O. H. A. Ageing (Ed.). Canberra, Australia: Australian Government, National Health and Medical Research Council.

  22. Curioni, C., & Lourenco, P. (2005). Long-term weight loss after diet and exercise: A systematic review. International Journal of Obesity, 29(10), 1168–1174.

    Article  CAS  PubMed  Google Scholar 

  23. Franz, M. J., VanWormer, J. J., Crain, A. L., Boucher, J. L., Histon, T., Caplan, W., et al. (2007). Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. Journal of the American Dietetic Association, 107(10), 1755–1767.

    Article  PubMed  Google Scholar 

  24. Kolotkin, R. L., Crosby, R. D., Williams, G. R., Hartley, G. G., & Nicol, S. (2001). The relationship between health-related quality of life and weight loss. Obesity Research, 9(9), 564–571.

    Article  CAS  PubMed  Google Scholar 

  25. Koohkan, S., Schaffner, D., Milliron, B. J., Frey, I., König, D., Deibert, P., et al. (2014). The impact of a weight reduction program with and without meal-replacement on health related quality of life in middle-aged obese females. BMC Women’s Health, 14(1), 45.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bish, C. L., Michels Blanck, H., Maynard, L. M., Serdula, M. K., Thompson, N. J., & Kettel Khan, L. (2006). Health-related quality of life and weight loss among overweight and obese U.S. adults, 2001 to 2002. Obesity (Silver Spring, Md.), 14(11), 2042–2053.

  27. Bize, R., Johnson, J. A., & Plotnikoff, R. C. (2007). Physical activity level and health-related quality of life in the general adult population: A systematic review. Preventive Medicine, 45(6), 401–415.

    Article  PubMed  Google Scholar 

  28. Kolotkin, R., LaMonte, M., Litwin, S., Crosby, R., Gress, R., Yanowitz, F., et al. (2011). Cardiorespiratory fitness and health-related quality of life in bariatric surgery patients. Obesity Surgery, 21(4), 457–464.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Martin, C. K., Church, T. S., Thompson, A. M., Earnest, C. P., & Blair, S. N. (2009). Exercise dose and quality of life: A randomized controlled trial. Archives of Internal Medicine, 169(3), 269–278.

    Article  PubMed  PubMed Central  Google Scholar 

  30. American College of Sports Medicine. (2013). ACSM’s guidelines for exercise testing and prescription: Lippincott Williams & Wilkins.

  31. Stewart, K. J., Turner, K. L., Bacher, A. C., DeRegis, J. R., Sung, J., Tayback, M., et al. (2003). Are fitness, activity, and fatness associated with health-related quality of life and mood in older persons? Journal of Cardiopulmonary Rehabilitation, 23(2), 115–121.

    Article  PubMed  Google Scholar 

  32. Spronk, S., Bosch, J. L., Veen, H. F., den Hoed, P. T., & Hunink, M. M. (2005). Intermittent claudication: Functional capacity and quality of life after exercise training or percutaneous transluminal angioplasty—Systematic review 1. Radiology, 235(3), 833–842.

    Article  PubMed  Google Scholar 

  33. Netz, Y., Wu, M.-J., Becker, B. J., & Tenenbaum, G. (2005). Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies. Psychology and Aging, 20(2), 272.

    Article  PubMed  Google Scholar 

  34. Oldervoll, L., Kaasa, S., Hjermstad, M., Lund, J., & Loge, J. (2004). Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? European Journal of Cancer, 40(7), 951–962.

    Article  CAS  PubMed  Google Scholar 

  35. Annesi, J. J. (2012). Supported exercise improves controlled eating and weight through its effects on psychosocial factors: Extending a systematic research program toward treatment development. The Permanente Journal, 16(1), 7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Vuillemin, A., Boini, S., Bertrais, S., Tessier, S., Oppert, J.-M., Hercberg, S., et al. (2005). Leisure time physical activity and health-related quality of life. Preventive Medicine, 41(2), 562–569.

    Article  PubMed  Google Scholar 

  37. Brown, D. W., Balluz, L. S., Heath, G. W., Moriarty, D. G., Ford, E. S., Giles, W. H., et al. (2003). Associations between recommended levels of physical activity and health-related quality of life findings from the 2001 Behavioral risk Factor Surveillance System (BRFSS) survey. Preventive Medicine, 37(5), 520–528.

    Article  PubMed  Google Scholar 

  38. Brown, D. W., Brown, D. R., Heath, G. W., Balluz, L., Giles, W. H., Ford, E. S., et al. (2004). Associations between physical activity dose and health-related quality of life. Medicine and Science in Sports and Exercise, 36(5), 890–896.

    Article  PubMed  Google Scholar 

  39. Nicolucci, A., Balducci, S., Cardelli, P., Cavallo, S., Fallucca, S., Bazuro, A., et al. (2012). Relationship of exercise volume to improvements of quality of life with supervised exercise training in patients with type 2 diabetes in a randomised controlled trial: The Italian Diabetes and Exercise Study (IDES). Diabetologia, 55(3), 579–588.

    Article  CAS  PubMed  Google Scholar 

  40. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151(4), W-65.

  41. Ware Jr, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 473–483.

  42. Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology and Community Health, 52(6), 377–384.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Imayama, I., Alfano, C. M., Kong, A., Foster-Schubert, K. E., Bain, C. E., Xiao, L., et al. (2011). Dietary weight loss and exercise interventions effects on quality of life in overweight/obese postmenopausal women: A randomized controlled trial. The International Journal Of Behavioral Nutrition And Physical Activity, 8, 118.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., DeVita, P., et al. (2013). 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. JAMA: The Journal of the American Medical Association, 310(12), 1263–1273.

    Article  CAS  PubMed  Google Scholar 

  45. Messier, V., Hayek, J., Karelis, A. D., Messier, L., Doucet, E., Prud’homme, D., et al. (2010). Anthropometric, metabolic, psychosocial and dietary factors associated with dropout in overweight and obese postmenopausal women engaged in a 6-month weight loss programme: A MONET study. The British Journal Of Nutrition, 103(8), 1230–1235.

    CAS  PubMed  Google Scholar 

  46. Napoli, N., Shah, K., Waters, D. L., Sinacore, D. R., Qualls, C., & Villareal, D. T. (2014). Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. American Journal of Clinical Nutrition, 100(1), 189–198.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Nieman, D. C., Custer, W. F., Butterworth, D. E., Utter, A. C., & Henson, D. A. (2000). Psychological response to exercise training and/or energy restriction in obese women. Journal of Psychosomatic Research, 48(1), 23–29.

    Article  CAS  PubMed  Google Scholar 

  48. Scott, H. A., Gibson, P. G., Garg, M. L., Pretto, J. J., Morgan, P. J., Callister, R., et al. (2013). Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: A randomized trial. Clinical And Experimental Allergy: Journal Of The British Society For Allergy And Clinical Immunology, 43(1), 36–49.

    Article  CAS  Google Scholar 

  49. Snel, M., Sleddering, M. A., Vd Peijl, I. D., Romijn, J. A., Pijl, H., Meinders, A. E., et al. (2012). Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise. European Journal Of Internal Medicine, 23(2), 143–149.

    Article  PubMed  Google Scholar 

  50. Thomson, R. L., Buckley, J. D., Lim, S. S., Noakes, M., Clifton, P. M., Norman, R. J., et al. (2010). Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertility and Sterility, 94(5), 1812–1816.

    Article  PubMed  Google Scholar 

  51. Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., et al. (2011). Weight loss, exercise, or both and physical function in obese older adults. The New England Journal of Medicine, 364(13), 1218–1229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Messier, V., Rabasa-Lhoret, R., Doucet, E., Brochu, M., Lavoie, J.-M., Karelis, A., et al. (2010). Effects of the addition of a resistance training programme to a caloric restriction weight loss intervention on psychosocial factors in overweight and obese post-menopausal women: A Montreal Ottawa New Emerging Team Study. Journal of Sports Sciences, 28(1), 83–92.

    Article  PubMed  Google Scholar 

  53. Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., et al. (2011). 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. Medicine and Science in Sports and Exercise, 43(7), 1334–1359.

    Article  PubMed  Google Scholar 

  54. Chassany, O., Sagnier, P., Marquis, P., Fullerton, S., & Aaronson, N. (2002). Patient-reported outcomes: The example of health-related quality of life—a European guidance document for the improved integration of health-related quality of life assessment in the drug regulatory process. Drug Information Journal, 36(1), 209–238.

    Article  Google Scholar 

  55. Ware, J., Kosinski, M., & Dewey, J. (2000). How to score version two of the SF-36(R) Health Survey.

  56. Kolotkin, R. L., Head, S., & Brookhart, A. (1997). Construct validity of the impact of weight on quality of life questionnaire. Obesity Research, 5(5), 434–441.

    Article  CAS  PubMed  Google Scholar 

  57. Kolotkin, R. L., Head, S., Hamilton, M., & Tse, C.-K. J. (1995). Assessing impact of weight on quality of life. Obesity Research, 3(1), 49–56.

    Article  CAS  PubMed  Google Scholar 

  58. Juniper, E. F., Guyatt, G. H., Ferrie, P. J., & Griffith, L. E. (1993). Measuring quality of life in asthma. American Review of Respiratory Disease, 147(4), 832–838.

    Article  CAS  PubMed  Google Scholar 

  59. Leidy, N., & Coughlin, C. (1998). Psychometric performance of the asthma quality of life questionnaire in a US sample. Quality of Life Research, 7(2), 127–134.

    Article  CAS  PubMed  Google Scholar 

  60. McDowell, I., & Newell, C. (1996). Measuring health. A guide to rating scales and questionnaires, 2.

  61. Cronin, L., Guyatt, G., Griffith, L., Wong, E., Azziz, R., Futterweit, W., et al. (1998). Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS) 1. The Journal of Clinical Endocrinology & Metabolism, 83(6), 1976–1987.

    CAS  Google Scholar 

  62. Altman, D. G., Schulz, K. F., Moher, D., Egger, M., Davidoff, F., Elbourne, D., et al. (2001). The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Annals of Internal Medicine, 134(8), 663–694.

    Article  CAS  PubMed  Google Scholar 

  63. Wiklund, I., Dimenäs, E., & Wahl, M. (1990). Factors of importance when evaluating quality of life in clinical trials. Controlled Clinical Trials, 11(3), 169–179.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Physical Activity and Nutrition, Deakin University Australia, Geelong, Australia

    Daniel J. van den Hoek, Clint T. Miller & Steve F. Fraser

  2. School of Exercise and Nutrition Sciences, Deakin University Australia, Geelong, Australia

    Daniel J. van den Hoek, Clint T. Miller, Steve F. Fraser & Steve E. Selig

  3. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    John B. Dixon

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  1. Daniel J. van den Hoek
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  2. Clint T. Miller
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Correspondence to Daniel J. van den Hoek.

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van den Hoek, D.J., Miller, C.T., Fraser, S.F. et al. Does exercise training augment improvements in quality of life induced by energy restriction for obese populations? A systematic review. Qual Life Res 26, 2593–2605 (2017). https://doi.org/10.1007/s11136-017-1602-9

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