To investigate the effects of aerobic training, resistance training, or both on abdominal subcutaneous fat (subcutaneous adipose tissue (SAT)) (deep and superficial), visceral fat (visceral adipose tissue (VAT)), apolipoproteins A-1 and B (ApoA-1, ApoB), ApoB/ApoA-1 ratio and high-sensitivity C-reactive protein (HSCRP) in post-pubertal adolescents with obesity.
After a 4-week supervised moderate-intensity exercise run-in period, 304 postpubertal adolescents with overweight (body mass index (BMI) ⩾85th percentile for age and sex+diabetes risk factor) or obesity (⩾95th BMI percentile) aged 14–18 years were randomized to four groups for 22 weeks (5 months): aerobic training, resistance training, combined training or a non-exercising control.
This study used a randomized controlled design. All groups received dietary counseling designed to promote healthy eating with a maximum daily energy deficit of 250 kcal. Abdominal fat (SAT and VAT) at the level of the fourth and fifth lumbar vertebrae (L4–L5) was measured by magnetic resonance imaging and ApoA-1, ApoB and HSCRP were measured after a 12-h fast at baseline and after 6 months.
Changes in SAT at L4–L5 were −16.2 cm2 in aerobic (P=0.04 vs control), −22.7 cm2 in resistance (P=0.009 vs control) and −18.7 cm2 in combined (P=0.02 vs control). Combined training reduced ApoB levels from 0.81±0.02 to 0.78±0.02 g l–1 (P=0.04 vs control) and ApoB/ApoA-1 ratio from 0.67±0.02 to 0.64±0.02 (P=0.02 vs control and P=0.04 vs aerobic). There were no significant differences in VAT, ApoA-1 or HSCRP levels between groups.
Aerobic and resistance training and their combination decreased abdominal SAT in adolescents with obesity. Combined training caused greater improvements in ApoB/ApoA-1 ratio compared with aerobic training alone.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Metabolically healthy obesity and physical fitness in military males in the CHIEF study
Scientific Reports Open Access 27 April 2021
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Xi B, Mi J, Zhao M, Zhang T, Jia C, Li J et al. Trends in abdominal obesity among US children and adolescents. Pediatrics 2014; 134: e334–e339.
Gutin B, Johnson MH, Humphries MC, Hatfield-Laube JL, Kapuku GK, Allison JD et al. Relationship of visceral adiposity to cardiovascular disease risk factors in black and white teens. Obesity (Silver Spring) 2007; 15: 1029–1035.
Ross R, Aru J, Freeman J, Hudson R, Janssen I . Abdominal adiposity and insulin resistance in obese men. Am J Physiol Endocrinol Metab 2002; 282: E657–E663.
Ross R, Freeman J, Hudson R, Janssen I . Abdominal obesity, muscle composition, and insulin resistance in premenopausal women. J Clin Endocrinol Metab 2002; 87: 5044–5051.
Walker GE, Verti B, Marzullo P, Savia G, Mencarelli M, Zurleni F et al. Deep subcutaneous adipose tissue: a distinct abdominal adipose depot. Obesity (Silver Spring) 2007; 15: 1933–1943.
Walker GE, Marzullo P, Verti B, Guzzaloni G, Maestrini S, Zurleni F et al. Subcutaneous abdominal adipose tissue subcompartments: potential role in rosiglitazone effects. Obesity (Silver Spring) 2008; 16: 1983–1991.
Ford ES . Body mass index, diabetes, and C-reactive protein among U.S. adults. Diabetes Care 1999; 22: 1971–1977.
Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB . Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999; 282: 2131–2135.
Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V . Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis 2000; 148: 209–214.
Barbeau P, Litaker MS, Woods KF, Lemmon CR, Humphries MC, Owens C et al. Hemostatic and inflammatory markers in obese youths: effects of exercise and adiposity. J Pediatr 2002; 141: 415–420.
Ridker PM . Evaluating novel cardiovascular risk factors: can we better predict heart attacks? Ann Intern Med 1999; 130: 933–937.
Ridker PM, Hennekens CH, Buring JE, Rifai N . C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836–843.
Lamarche B, Tchernof A, Mauriege P, Mauriege P, Cantin B, Dagenais GR et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998; 279: 1955–1961.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.
McQueen MJ, Hawken S, Wang X, Ounpuu S, Sniderman A, Probstfield J et al. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet 2008; 372: 224–233.
van Holten TC, Waanders LF, de Groot PG, Vissers J, Hoefer IE, Pasterkamp G et al. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One 2013; 8: e62080.
Lee S, Bacha F, Hannon T, Kuk JL, Boesch C, Arslanian S . Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial. Diabetes 2012; 61: 2787–2795.
Alberga AS, Goldfield GS, Kenny GP, Hadjiyannakis S, Phillips P, Prud'homme D et al. Healthy Eating, Aerobic and Resistance Training in Youth (HEARTY): study rationale, design and methods. Contemp Clin Trials 2012; 33: 839–847.
Sigal RJ, Alberga AS, Goldfield GS, Hadjiyannakis S, Gougeon R, Phillips P et al. Effects of aerobic training, resistance training, or both on percent body fat and cardiometabolic risk markers in obese adolescents: the HEARTY trial. JAMA Pediatr 2014; 168: 1006–1014.
Lee S, Janssen I, Ross R . Interindividual variation in abdominal subcutaneous and visceral adipose tissue: influence of measurement site. J Appl Physiol 2004; 97: 948–954.
Ross R, Leger L, Morris D, de Guise J, Guardo R . Quantification of adipose tissue by MRI: relationship with anthropometric variables. J Appl Physiol 1992; 72: 787–795.
Kuk JL, Lee S, Heymsfield SB, Ross R . Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005; 81: 1330–1334.
Lee S, Deldin AR, White D, Kim Y, Libman I, Rivera-Vega M et al. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol Metab 2013; 305: E1222–E1229.
Comuzzie AG, Higgins PB, Voruganti S, Cole S . Cutting the fat: the genetic dissection of body weight. Prog Mol Biol Transl Sci 2010; 94: 197–212.
Katzmarzyk PT, Perusse L, Bouchard C . Genetics of abdominal visceral fat levels. Am J Hum Biol 1999; 11: 225–235.
Suliga E . Visceral adipose tissue in children and adolescents: a review. Nutr Res Rev 2009; 22: 137–147.
Alberga AS, Prud'homme D, Kenny GP, Goldfield GS, Hadiyannakis S, Gougeon R et al. Effects on resting energy expenditure, aerobic and musculoskeletal fitness: the HEARTY exercise trial. Can J Diabetes 2013; 37: 2.
Lazzer S, Boirie Y, Montaurier C, Vernet J, Meyer M, Vermorel M . A weight reduction program preserves fat-free mass but not metabolic rate in obese adolescents. Obes Res 2004; 12: 233–240.
Markman B, Barton FE Jr . Anatomy of the subcutaneous tissue of the trunk and lower extremity. Plast Reconstr Surg 1987; 80: 248–254.
Smith SR, Lovejoy JC, Greenway F, Ryan D, deJonge L, de la Bretonne J et al. Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Metabolism 2001; 50: 425–435.
Miyazaki Y, Glass L, Triplitt C, Wajcberg E, Mandarino LJ, DeFronzo RA . Abdominal fat distribution and peripheral and hepatic insulin resistance in type 2 diabetes mellitus. Am J Physiol Endocrinol Metab 2002; 283: E1135–E1143.
Mohamed-Ali V, Goodrick S, Rawesh A, Katz DR, Miles JM, Yudkin JS et al. Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab 1997; 82: 4196–4200.
Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW . C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999; 19: 972–978.
Balagopal P, George D, Patton N, Yarandi H, Roberts WL, Bayne E et al. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr 2005; 146: 342–348.
Meyer AA, Kundt G, Lenschow U, Schuff-Werner P, Kienast W . Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48: 1865–1870.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499–511.
Jarvisalo MJ, Harmoinen A, Hakanen M, Paakkunainen U, Viikari J, Hartiala J et al. Elevated serum C-reactive protein levels and early arterial changes in healthy children. Arterioscler Thromb Vasc Biol 2002; 22: 1323–1328.
Rosenbaum M, Nonas C, Weil R, Horlick M, Fennoy I, Vargas I et al. School-based intervention acutely improves insulin sensitivity and decreases inflammatory markers and body fatness in junior high school students. J Clin Endocrinol Metab 2007; 92: 504–508.
Park TG, Hong HR, Lee J, Kang HS . Lifestyle plus exercise intervention improves metabolic syndrome markers without change in adiponectin in obese girls. Ann Nutr Metab 2007; 51: 197–203.
Tsang TW, Kohn M, Chow CM, Singh MF . A randomized controlled trial of Kung Fu training for metabolic health in overweight/obese adolescents: the "martial fitness" study. J Pediatr Endocrinol Metab 2009; 22: 595–607.
Nassis GP, Papantakou K, Skenderi K, Triandafilopoulou M, Kavouras SA, Yannakoulia M et al. Aerobic exercise training improves insulin sensitivity without changes in body weight, body fat, adiponectin, and inflammatory markers in overweight and obese girls. Metabolism 2005; 54: 1472–1479.
Kim ES, Im JA, Kim KC, Park JH, Suh SH, Kang ES et al. Improved insulin sensitivity and adiponectin level after exercise training in obese Korean youth. Obesity (Silver Spring) 2007; 15: 3023–3030.
Wong PC, Chia MY, Tsou IY, Wansaicheong GK, Tan B, Wang JC et al. Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Ann Acad Med Singapore 2008; 37: 286–293.
The HEARTY trial was supported by a Canadian Institutes of Health Research (CIHR) grant (MCT-71979). Dr Alberga was supported by a Doctoral Student Research Award from the Canadian Diabetes Association (held at the Human and Environmental Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa) and currently by an Eyes High Postdoctoral Fellowship at the University of Calgary. Dr Goldfield was supported by a New Investigator Award from the Canadian Institutes of Health Research for part of the trial, and subsequently by an Endowed Research Scholarship from the Children's Hospital of Eastern Ontario Volunteer Association Board. Dr Sigal is supported by a Health Senior Scholar award from Alberta Innovates-Health Solutions, and was supported by a Research Chair from the Ottawa Hospital Research Institute during part of this trial. Dr Kenny is supported by a University of Ottawa Research Chair. We gratefully thank the HEARTY participants and all HEARTY research staff who assisted with training, data collection and analysis. Trial Registration: ClinicalTrials.Gov NCT00195858.
The authors declare no conflict of interest.
Supplementary Information accompanies this paper on International Journal of Obesity website
Rights and permissions
About this article
Cite this article
Alberga, A., Prud'homme, D., Kenny, G. et al. Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial. Int J Obes 39, 1494–1500 (2015). https://doi.org/10.1038/ijo.2015.133
This article is cited by
Metabolically healthy obesity and physical fitness in military males in the CHIEF study
Scientific Reports (2021)
Metabolic effects of resistance or high-intensity interval training among glycemic control-nonresponsive children with insulin resistance
International Journal of Obesity (2018)
Exercise-based interventions and C-reactive protein in overweight and obese youths: a meta-analysis of randomized controlled trials
Pediatric Research (2016)