Re: Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR


"Chris Malcolm" <cam@xxxxxxxxxxxxxxxxx> wrote in message news:8hlg40F22bU1@xxxxxxxxxxxxxxxxxxxxx
randy@xxxxxxx <randy@xxxxxxx> wrote:
Interesting experiement and findings.

Randy

The effects of total energy expenditure from all levels of physical
activity
vs. physical activity energy expenditure from moderate-to-vigorous
activity
on visceral fat and insulin sensitivity in obese Type 2 diabetic
women.
Koo BK, Han KA, Ahn HJ, Jung JY, Kim HC, Min KW.
Diabet Med. 2010 Sep;27(9):1088-92.
PMID: 20722686
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03045.x/full
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03045.x/pdf

Abstract

AIMS: We examined the effects of physical activity with or without
dietary
restriction for 3 months on regional fat and insulin sensitivity and
compared the effect of total energy expenditure from all levels of
physical
activity with that of physical activity energy expenditure from
moderate-to-vigorous exercise in obese women with Type 2 diabetes.

METHODS: In this randomized, controlled trial, we assessed change of
body
weight, abdominal visceral fat area, subcutaneous fat area and
insulin
sensitivity, expressed as K(ITT), and monitored total energy
expenditure and
physical activity energy expenditure using an accelerometer during a
12-week
intervention in four groups: control, diet, exercise and diet plus
exercise.

RESULTS: The mean body mass index was 28.0 +/- 2.7 kg/m(2) and the
mean
duration of diabetes was 8 +/- 6 years. Both the diet and diet plus
exercise
groups showed significant body weight loss compared with the control
group
(P < 0.05). However, the visceral fat area was reduced only in the
diet and
exercise group (P = 0.017) and the subcutaneous fat area was reduced
only in
the diet group (P = 0.009). Mean energy intake was an independent
determinant of the change in subcutaneous fat area (P = 0.020) and
mean
total energy expenditure was an independent determinant of visceral
fat area
(P = 0.002). Insulin sensitivity K(ITT) was associated with physical
activity energy expenditure (P = 0.006), energy intake (P = 0.047) and
the
change in fructosamine level (P = 0.016) but not with changes in body
weight, subcutaneous fat area, visceral fat area or adipokine level.

CONCLUSIONS: Exercise had an additive effect to dietary restriction
on
visceral fat reduction. Visceral fat area was associated with total
energy
expenditure, but insulin sensitivity was associated with physical
activity
energy expenditure.

They don't mention the type of exercise in the abstract. There are a
number of studies which suggest that for preferential visceral fat
reduction walking is the best exercise. The amount recommended varies
from about 30 minutes walking most days a week to 60 minutes daily of
brisk walking. My wife asked her osteopath how best to reduce belly
fat and was given the answer of at least 45 minutes walking 5 days a
week.

So I was curious to see what kinds of exercise this study was based
They don't mention the type of exercise in the abstract. There are a
number of studies which suggest that for preferential visceral fat
reduction walking is the best exercise. The amount recommended varies
from about 30 minutes walking most days a week to 60 minutes daily of
brisk walking. My wife asked her osteopath how best to reduce belly
fat and was given the answer of at least 45 minutes walking 5 days a
week.

So I was curious to see what kinds of exercise this study was based
on. This is what the full text (unforunately subscription only) says:

"The control and diet groups were given conventional exercise
education at the beginning of the study; namely, 150 min or more per
week [2]. The exercise and diet plus exercise groups were requested to
walk briskly for 120 min every day, which corresponds to an energy
expenditure of approximately 500 kcal/day [3], and this was reinforced
by a professional exercise therapist every 2 weeks based on data from
the accelerometer (Lifecorder Suzuken Co., Nagoya, Japan). All
subjects were requested to attach an accelerometer to their belts all
day long during the intervention period. Data from the accelerometers
were analysed using physical activity analysis software v1.0 [4] to
determine energy expenditure: physical activity energy expenditure was
defined as energy expenditure from moderate or vigorous physical
activity (. 4 metabolic equivalents) and total energy expenditure from
basal metabolism and light activity (< 4 metabolic equivalents) plus
physical activity energy expenditure [4]. Those who did not visit the
hospital on four consecutive occasions or who could not reach 80% of
goal of intervention were excluded from the study."

So they distinguished between the control amount of normal
conventional amounts of exercise of 150mins a week, i.e. 30 mins five
days a week, and their more intensive intervention of 120 mins a day.

They assessed the different effects on glucose sensitivity.

"All intervention groups but not the control group exhibited an
improvement in HbA1c level after 12 weeks (P < 0.05) and there was no
difference in levels among groups (Table 1). However, more subjects in
the diet and diet and exercise groups could reduce or stop their
anti-diabetic medication compared with the control group: 45% in the
diet group, 57.1% in the diet and exercise group and 5.6% in the
control group (P < 0.01). Only 15.4% of the exercise group could
reduce their medication; which was not statistically different from
that of the controls.All intervention groups but not the control group
exhibited an improvement in HbA1c level after 12 weeks (P < 0.05) and
there was no difference in levels among groups (Table 1). However,
more subjects in the diet and diet and exercise groups could reduce or
stop their anti-diabetic medication compared with the control group:
45% in the diet group, 57.1% in the diet and exercise group and 5.6%
in the control group (P < 0.01). Only 15.4% of the exercise group
could reduce their medication; which was not statistically different
from that of the controls."

So with respect to being able to reduce or stop their diabetic
medications the weight loss diet was 45% effective, and adding the
120mins daily exercise improved that to 57.1%.

They also assessed the effects on preferential visceral fat reduction.

"Dietary restriction is known as the most effective method for
decreasing body weight via a negative energy balance [7.9] and we
confirmed this: only groups subjected to energy restriction, with or
without exercise, showed a significant body weight reduction. In
addition, exercise intervention plus dietary restriction reduced the
visceral fat level significantly, with a similar amount of change in
body weight to that of the diet group. There has been much debate on
the additional effect of the exercise to dietary restriction, even in
the recent two well-controlled randomized trials [10,11] in which
energy intake and the amount of supervised exercise were objectively
measured. However, few studies examined the energy expenditure during
the free-living state beyond exercise. We monitored all the activities
from daily living to distinguish between physical activity energy
expenditure and total energy expenditure and found that total, but not
physical activity energy expenditure, was an independent determinant
of the change in visceral fat area, which suggests that uncontrolled
energy expenditure during non-structured activities in the prior
studies might have brought the different results."

So we're left uncertain as to how much walking was involved in the
controlled structured 120 mins of exercise a day. Nice however to have
the suggestion that "uncontrolled energy expenditure" in "unstructured
activities" might actually be useful. Something to mention to those
who are convinced that informal unstructured exercise "doesn't count"
:-)

My own personal suspicion, which I haven't yet been able to
substantiate with appropriately detailed and controlled studies, is
that walking is peculiarly effective in reducing visceral fat.

--
Chris Malcolm


Good point about the unstructured exercise.

120 min of brisk walking every day is not something the vast majority of people are going to be willing and able to do.

If walking is in fact "peculiarly effective" in reducing visceral fat, I would bet the reason is that cortisol (the "stress hormone") increases visceral fat, and walking is particularly good for relieving stress. However, the study seems to indicate that "total energy expenditure", NOT "physical activity energy expenditure", was shown to be the determinant of the change in visceral fat.

.

Relevant Pages

  • Re: Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR
    ... vs. physical activity energy expenditure from moderate-to-vigorous ... on visceral fat and insulin sensitivity in obese Type 2 diabetic ... moderate-to-vigorous exercise in obese women with Type 2 diabetes. ...
    (alt.support.diabetes)
  • Re: Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR
    ... vs. physical activity energy expenditure from moderate-to-vigorous ... on visceral fat and insulin sensitivity in obese Type 2 diabetic ... So I was curious to see what kinds of exercise this study was based ... physical activity energy expenditure was ...
    (alt.support.diabetes)
  • Re: Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR
    ... vs. physical activity energy expenditure from moderate-to-vigorous ... on visceral fat and insulin sensitivity in obese Type 2 diabetic ... They don't mention the type of exercise in the abstract. ... physical activity energy expenditure was ...
    (alt.support.diabetes)
  • Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR
    ... The effects of total energy expenditure from all levels of physical ... vs. physical activity energy expenditure from moderate-to-vigorous ... on visceral fat and insulin sensitivity in obese Type 2 diabetic ... weight, abdominal visceral fat area, subcutaneous fat area and ...
    (alt.support.diabetes)
  • Re: Obese diabetic women CR -+ Exercise, Belly/Skin fat, IR
    ... The effects of total energy expenditure from all levels of physical ... vs. physical activity energy expenditure from moderate-to-vigorous ... weight, abdominal visceral fat area, subcutaneous fat area and ...
    (alt.support.diabetes)