Abstract (Okura T in AFSM 2005)

   Because weight-loss treatment benefits the health of obese individuals, obese patients with risk factors for coronary heart disease (CHD) should be treated by an appropriate weight-loss program. To prevent weight regain after weight loss, it has been recommended that obesity be treated with a combination of physical exercise and reduced energy intake.

   We have recommended obese people to take diet less than 1200 kcal/d for women and 1600 kcal/d for men during the treatment period. They kept food diaries and learned about proper daily nutrition through weekly lectures and counseling by dieticians. As exercise trainings, we have recommended walking and aerobic dance (bench-stepping exercise). Walking is accessible to many segments of the population because it is convenient, easy and low cost. The bench-stepping exercise is a popular exercise particularly among women, and is a combination exercise of low impact aerobic dance and stepping with a step bench (10 to 20 cm high). The obese people were instructed to perform walking or the bench-stepping exercise for more than 1000 kcal/wk. We have demonstrated various effects of these aerobic exercises with diet in the treatment of obesity. The followings are our major outcomes.

   Improvement in CHD risk factors with weight loss: Five criteria for CHD risk factors were defined: 1) systolic blood pressure (SBP)?140 mmHg; 2) diastolic blood pressure (DBP)?90 mmHg; 3) total cholesterol (TC)?220 mg/dL; 4) triglycerides (TG)?150 mg/dL; and 5) fasting plasma glucose (FPG)?126 mg/dL. Obese women were divided into diet alone (DA, n=72) and die plus exercise (DE, n=207) groups. Number of CHD risk factors per person was clearly decreased in both groups with DA (1.38±1.09→0.65±0.81, p<0.0001) and DE (1.20±1.14→0.56±0.79, p<0.0001) with significant reductions in body weight (-7.3 kg and -8.4 kg, respectively) and body mass index (-3.0 kg/2 and -3.4 kg/m2, respectively).

   Effect of exercise training on body composition change: Relative (%) reduction in fat free mass (FFM) was greater in a group with DA (19.4% of total weight loss, n=64) compared with a group with DE (9.5%, n=142). For total subjects, a percentage reduction in FFM for the total weight loss was 12.6%.

   Effect of exercise intensity on CHD risk factors: Ninety obese women were divided into DA, diet plus walking (Dwalking), and diet plus aerobic dance (Ddance) groups. Reductions in low density lipoprotein-cholesterol and FPG were significantly greater (p < 0.05) in the Ddance group compared with the DA and Dwalking groups. Adding higher intensity aerobic dance to a diet may be more effective in improving CHD risk factors compared with low-intensity walking.
    Specific effect of aerobic exercise on visceral fat reduction: It is controversial whether aerobic exercise would give a bigger reduction in visceral fat even when a same energy deficit was presented between exercise and diet. Visceral fat reduction was significantly (p<0.01) greater in DE group (-49.3 cm2) than in DA group (-37.8 cm2). The efficacy on reducing visceral fat of adding aerobic exercise to a diet-alone program may be more prominent (-49.3 cm2/-37.8 cm2 = 1.3 times) compared with DA.

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