Individualized Exercise Training at Maximal Fat Oxidation Combined with Fruit and Vegetable-Rich

18 Pages·2017·0.5 MB·English

RESEARCHARTICLE
Individualized Exercise Training at Maximal
Fat Oxidation Combined with Fruit and
Vegetable-Rich Diet in Overweight or Obese
Women: The LIPOXmax-Réunion
Randomized Controlled Trial
FlorentBesnier1*,VictorineLenclume1,PatrickGérardin1,AdrianFianu1,
JérémyMartinez1,NadègeNaty1,SylvainePorcherat1,KarimBoussaid1,
StéphaneSchneebeli2,EricJarlet2,SarahHatia3,GeorgesDalleau4,ChantalVerkindt4,
Jean-FrédéricBrun5,Marie-PauleGonthier3,FrançoisFavier1
1 INSERM,CIC1410,Saint-Pierre,F-97410,France,2 UnitofDiabetology,Endocrinology,Metabolic
Diseases,UniversityHospitalofLaRéunion,SaintPierre,LaRéunion,3 UMRDETROI,INSERMU1188,
UniversityofLaReunion,SainteClotilde,LaRéunion,4 InterculturalDeterminantsofMotricityandSports
PerformanceResearchGroup(DIMPS),UniversityofLaRéunion,LeTampon,LaRéunion,5 Departmentof
ClinicalPhysiology(CERAMM,U1046INSERM),UniversityHospitalofMontpellier,France,UMR9214
OPENACCESS CNRS,«physiologyandexperimentalmedicine:heart–muscles»,UniversityofMontpellier,Montpellier,
France
Citation:BesnierF,LenclumeV,GérardinP,Fianu
A,MartinezJ,NatyN,etal.(2015)Individualized *[email protected]
ExerciseTrainingatMaximalFatOxidation
CombinedwithFruitandVegetable-RichDietin
OverweightorObeseWomen:TheLIPOXmax-
Abstract
RéunionRandomizedControlledTrial.PLoSONE10
(11):e0139246.doi:10.1371/journal.pone.0139246
Editor:NoelChristopherBarengo,Universityof
Tolima,COLOMBIA
Objectives
Received:March17,2015
Lifestylecombinedinterventionsareakeystrategyforpreventingtype-2diabetes(T2DM)
Accepted:September6,2015 inoverweightorobesesubjects.Inthisframework,LIPOXmaxindividualizedtraining,
Published:November10,2015 basedonmaximalfatoxidation[MFO],maybeapromisinginterventiontopromotefatmass
(FM)reductionandpreventT2DM.Ourprimaryobjectivewastocomparethreetrainingpro-
Copyright:©2015Besnieretal.Thisisanopen
accessarticledistributedunderthetermsofthe gramsofphysicalactivitycombinedwithafruit-andvegetable-richdietinreducingFMin
CreativeCommonsAttributionLicense,whichpermits overweightorobesewomen.
unrestricteduse,distribution,andreproductioninany
medium,providedtheoriginalauthorandsourceare
credited.
Designandsetting
DataAvailabilityStatement:Allrelevantdataare
Afivemonthsnon-blindedrandomizedcontrolledtrial(RCT)withthreeparallelgroupsinLa
withinthepaperanditsSupportingInformationfiles.
RéunionIsland,aregionwheremetabolicdiseasesarehighlyprevalent.
Funding:TheCentreHospitalierUniversitaireofLa
Réunionwasthestudysponsor.Thisresearchwas
supportedbygrantsofLaRéunionislandauthorities
Subjects
(CPER2012)andbytheEuropeanResearchand
DevelopmentFund(POCTFEDER2007–2013).The Onehundredandthirty-sixnon-diabeticobese(bodymassindex[BMI]:27–40kg/m2)
fundershadnoroleinstudydesign,datacollection
youngwomen(aged20–40)wererandomized(G1:MFOintensity;G2:60%ofVO -peak
andanalysis,decisiontopublish,orpreparationof 2
themanuscript. intensity;G3:freemoderate-intensityat-homeexercisefollowinggoodphysicalpractices).
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LIPOXmaxRéunion
CompetingInterests:Theauthorshavedeclared Outcomes
thatnocompetinginterestsexist.
Anthropometry(BMI,bodyweight,FM,fat-freemass),glucose(fastingplasmaglucose,
Abbreviations:BMI,bodymassindex;CHO,
insulin,HOMA-IR)andlipid(cholesterolandtriglycerides)profiles,andMFOvalueswere
carbohydratesoxidation;CO2,carbondioxide
measuredatmonth-0,month-3andmonth-5.
production;CVD,cardiovasculardiseases;FFM,fat
freemass;FM,fatmass;FPG,fastingplasma
glucose;GPP,guidelineofgoodphysicalpractices; Results
HbA1c,glycosylatedhaemoglobin;HIIE,high-
intensityintermittentexercises;HISS,high-intensity Atmonth-5,among109womenassessedonbodycomposition,thethreegroupsexhibited
steadystate;HR,heartrate;MAP,maximalaerobic asignificantFMreductionovertime(G1:-4.1±0.54kg;G2:-4.7±0.53kg;G3:-3.5±0.78kg,
power;MFO,maximalfatoxidation;PA,physical p<0.001,respectively)withoutinter-groupdifferences(p=0.135).Allgroupsexhibitedsig-
activity;RCT,randomizedcontrolledtrial;RER,
nificantreductionsininsulinlevelsorHOMA-IRindex,andhigherMFOvaluesovertime
respiratoryexchangeratio;SSE,steadystate
exercises;T2DM,type-2diabetesmellitus;VO2, (p<0.001,respectively)butglucosecontrolimprovementwashigherinG1thaninG3while
oxygenconsumption;WHO,WorldHealth MFOvalueswerehigherinG1thaninG2andG3.Changesinotheroutcomemeasures
Organization.
andinter-groupdifferenceswerenotsignificant.
Conclusion
InourRCTtheLIPOXmaxinterventiondidnotshowasuperiorityinreducingFMinover-
weightorobesewomenbutisassociatedwithhigherMFOandbetterglucosecontrol
improvements.OtherstudiesarerequiredbeforeproposingLIPOXmaxtrainingforthepre-
ventionofT2DMinoverweightorobesewomen.
TrialRegistration
ClincialTrials.govNCT01464073
Introduction
Overthepastthreedecades,theburdenofobesityhasnearlydoubledworldwide[1].Indeed,
accordingtoarecentWorldHealthOrganization(WHO)report,1.46billionadultswereover-
weight(bodymassindex[BMI](cid:1)25kg/m²)in2008,andofthese,205millionmenand297
millionwomenwereobese(BMI(cid:1)30kg/m²).InLaRéunionIsland,Favierandco-workers
confirmedintheREDIAstudythatwomenhaveahigherprevalenceofoverweightorobesity
thanmen(47%vs43%,BMI>25kg/m²p=0.002)[2].
Thecausalrelationshipbetweenobesity,metabolicsyndrome(MS)andconditionssuchas
type-2diabetesmellitus(T2DM),cardiovasculardiseases(CVD)andcancerisnowwelldocu-
mented.[3]Thus,inoursetting,sedentarylifestyleandthehighprevalenceofobesitymaypar-
tiallyexplainthehighprevalenceofT2DMinthe30–69agegroupforwomen(17.3%)[2,4].In
linewiththispicture,theliteraturededicatedtopreventivestrategiesforobesityandrelated
complicationsprovidesevidencethatlifestyleinterventionscombiningregularphysicalactivity
(PA)anddietwerecost-effective[5–8].Asvisceraladiposityisthemilestoneofcardiovascular
complications,itisthusimperativetoproposepreventivemeasuresbasedonfatmass(FM)
reductioninobesepeople.However,despitethehighlevelofproofsandindisputableuseful-
ness,thelevelofprescriptionofstrategiesbasedonregularPAremainspoorinthispopulation.
AccordingtotheAmericanCollegeofSportsMedicine,adose–responseisexpectedbetween
theamountofPAandtheintensityofweightreduction:“lessthan150minutesaweekofPA
promotesminimalweightloss,PA>150min/wkresultsinmoderateweightlossof~2–3kg,
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LIPOXmaxRéunion
PAbetween225–420min/weekresultsin5–7.5kgweightloss”.Importantly,“PAimproves
weightlosswhendietrestrictionismodestbutnotwhendietrestrictionissubstantial”[9].In
thisframework,agrowingbodyofevidencehasshownthatthebenefitsofPAinobesepeople
arelimitedwhenitisnotindividualized,regular,andbasedona“moderateintensity”.The
conceptofindividualizationofexercisetraininghasledsomeexpertstorecommendtheuseof
sub-maximalself-parametersforguidingtheprescriptionofPAexercises[10,11].Moreover,
Salvadegoandcoll[12].haveproposedthatPAprescriptioninobesepeopletakesintoaccount
the"metabolicanswer"totheeffort,representedbytheadaptationkineticsofseveralparame-
tersincludingoxidativemetabolismandexercisetolerancebiomarkers,andnotonlythemaxi-
maloxygenconsumption(VO2peak)orthemaximalheartrate(HRpeak).
Inthiscontext,thethresholdofmaximallipidoxidationhasbeensought[13].Thisisusu-
allymeasuredbyindirectcalorimetryduringanincrementalexercisetest.Accordingtothebal-
anceofcarbohydrateandlipidutilizationduringexercise[14],carbohydratesoxidation(CHO)
increasesproportionallytotheintensityofexercise,whereaslipidsoxidationreachesamaxi-
mumatanintensitydefiningthe“LIPOXmax”andthendecreases.LIPOXmaxdiffersbetween
individuals,anditsmeasureallowsthedetermination,foreachsubject,oftheoptimalintensity
inanefforttoachievemaximallipidconsumptionduringexercisesessions.Sofar,theuseof
indirectcalorimetryenablestheprescriptionofanindividualizedtrainingprograminorderto
optimizetheoxidationoflipids.SeveralworkshavehighlightedtheefficiencyofLIPOXmax
trainingonFMloss,glucosecontrolandmuscularmetabolisminobeseordiabeticsubjects
[15–27].However,inthesestudiesthelackofcontrolgroupdidnotallowtoconcludewhether
theimprovementsareduetotheLIPOXmaxtrainingortotheenduranceexercisetrainingper
se.Tothebestofourknowledge,nostudyhasyetcomparedtheindividualizedLIPOXmax
trainingtoastandardizedtrainingguidedbythepercentageofVO2peak,orbytheGuideline
ofGoodPhysicalPractices(GPP)inobesewomen.
AlongsideindividualizedPAtrainingprograms,theWHOencouragestheconsumptionof
atleastfiveportionsoffruitsandvegetablesperday[28].Micronutrients,fibre,andphyto-
chemicalsareassociatedwithriskreductionsofCVD[29]andT2DM[30].Furthermore,FM
lossisfacilitatedwhenafruitsandvegetablesdietiscombinedwithregularPA[9].Unfortu-
nately,obesesubjectsconsumefewervitaminsandantioxidantsoffruitsandvegetablesorigin
comparedwithnon-obesesubjects[31–33].Thus,fruitsandvegetablesconsumptionmustbe
stronglyencouragedinthisat-riskpopulation.
Theprimaryobjectiveofthe“LIPOXmax-Réunion”studywastocomparethreePAtraining
programscombinedwithfruitsandvegetablessupplementation,inreducingFMinoverweight
orobesesedentarywomen.Secondaryobjectivesweretoassesschangesinbodycomposition,
glucoseandlipidprofiles,andmaximalfatoxidationmeasures.
Methods
TheprotocoloftheLIPOXmax-RéunionRCTandsupportingCONSORTchecklistareavail-
ableassupportinginformation;seeS1Protocol(fullprotocolinFrench),S2Protocol(brief
Englishtranslation),andS1CONSORTChecklist.
Designandsetting
The“LIPOXmax-Réunion”studywasanon-blinded,randomizedcontrolledtrial(RCT)with
threeparallelgroups.Allparticipantswererecruitedinasinglecentre(CHUSud-Réunion)
betweenNovember2011andApril2012andfollowed-upoverfivemonths,betweenDecember
2011andSeptember2012.
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Participants
Afterprovidingwrittenconsentforparticipation,eligibleoverweightorobesewomenwere
enrolledinthestudy.Theeligiblecriteriawere,asfollows:agedbetween20and40,overweight
orobese(BMI:27to40kg/m²),sedentarylifestyle(<2hoursofPAperweek),clinicallystable,
namelynon-diabetic(fastingplasmaglucose<7mmol/L,HbA1c<6.5%),andabletopractise
exercisetraining.
Non-inclusioncriteriawerehypertension((cid:1)140/90mmHg),contra-indicationtoPAtrain-
ing,cardiovascularand/orrespiratorydiseasediagnosedbyacardiorespiratoryexercisetest,
myopathy,cancer,acuteandchronicinflammatorydiseases,end-stagerenaldisease,digestive
systemsurgery,previoustreatmentbysteroids,thyroidhormoneHRT,antidepressantsorneu-
roleptics,pregnancy,participationinthepreviousmonthinaprogramoftrainingoradiet.
Ethicsandfunding
ThisresearchwasapprovedbytheEthicalResearchCommitteeoftheUniversityofBordeaux
IIIandwasregisteredwithanapprovedICMJEclinicaltrialregistry:NCT01464073
ClinicalTrials.gov.https://clinicaltrials.gov/ct2/show/NCT01464073.Thisresearchwassup-
portedbygrantsofLaRéunionislandauthorities(CPER2012)andbytheEuropeanResearch
andDevelopmentFund(POCTFEDER2007–2013).Thesponsorsplayednoroleindetermin-
ingthestudydesign,datacollection,analysisandinterpretation,orwritingofthereport.The
correspondingauthorhadfullaccesstoallthedataandhadthefinalresponsibilityforthedeci-
siontosubmitforpublication.
Randomization
Afterinclusion,subjectswererandomlyassignedtooneofthethreegroups:G1(LIPOXmax);
G2(60%VO2max);G3(GPPat-home,30minutesminimumperdayatamoderateintensity).
RandomizationwasstratifiedonbaselineBMIstatusdefinedasfollows:stratum1:
27.0(cid:3)BMI<30.0kg/m²,stratum2:BMI(cid:1)30.0kg/m².Thetwolistsofrandomizationwere
providedbythestatisticianoftheCentreforClinicalInvestigation(AF)beforestartingthe
1
research,usingRallocprogramofStatav10.0 (randomizationbyblockwithequalblock
size=3,andbalancedallocationratio1:1:1).Thestatisticiangavetheindividualintervention’s
assignmenttotheresearchcoordinatorwhoinformedtheparticipant.
Intervention
Exercisetrainingprograms. AlltrainingsessionsforG1andG2wereperformedinthe
hospitaloncyclo-ergometers(CARE–SprinterXP)andweresupervisedbyaPAcoach(JM).
G1(LIPOXmax)wasconductedatalow-enduranceintensityelicitingthemaximallipidoxida-
tionmeasuredbyindirectcalorimetry,fourtimesaweekfor55minutes.G2(60%VO2max)
subjectsexercisedfourtimesaweekfor35minutesatmoderate-intensity,correspondingto
60%oftheVO2peak.ThedurationofPAwaslevelledbetweengroupstoanisocaloricexercise
persessionof20kJ.kgFatFreeMass-1.G3(GPPat-home)subjectswereassignedadailyfree
practiceof30minutesofmoderate-intensityexercise.Alltheparticipantsweregivenapedom-
1 1
eter(DistaNewfeel400 ),aHRmonitor(Kalenji300 )andaPAbookletwheretheduration
(minutes),intensity(recordedonaBorgscalegraded1to10),andthetypeofexercisehadto
benoted.Thisbookletwascheckedtwiceamonth.
Dietaryintervention. ToensureahealthybalanceddietthroughouttheRCT,allsubjects
participatedinanutritionaleducationalworkshopconductedbyadieticianpriortothestartof
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thePAprograms.Overthe5-monthinterventionperiod,allsubjectsreceivedafreesupple-
mentationoffiveportionsoffruitsandvegetablesaday.
Outcomemeasures. TheprimaryoutcomewastheFMchangeexpressedinkilograms
andmeasuredbyDualX-rayabsorptiometry(DXA–GEHealthcare,LittleChalfont,United
Kingdom)betweentheinclusion(M0)andtheendoftheinterventionatthefifthmonth(M5).
Secondaryoutcomesweremeasuredatinclusion(M0),atthethird-(M3)andatthefifth-
month(M5).Theyincludedtotalbodymass,FM,fatfreemass(FFM),plasmalipids(total
cholesterol,HDL-cholesterol,LDL-cholesterol,triglycerides),fastingplasmaglucose(FPG),
glycosylatedhaemoglobin(HbA c),insulinresistance(asmeasuredbytheHOMA-IRindex),
1
andtheexercise’smetabolicprofilewiththedeterminationofthemaximalfatoxidation
(MFO).
Anthropometricmeasures. Afterawholefastingnight,totalbodymassandregional
bodycompositionweremeasuredbyDXA.Heightwasmeasuredtothenearest0.5cmusinga
standardizedheightgauge.BMIwascalculatedasweight(kg)/height²(m).
Maximalcardiorespiratoryexercisetest. Cardiorespiratoryfitnesswasmeasuredduring
acyclo-ergometerincrementaltest(ErgolineBosch500,Berlin,Germany).Oxygen(VO )and
2
carbondioxide(CO )wereregisteredbyabreathbybreathanalysisandheartrate(HR)was
2
recordedcontinuouslybya12-leadelectrocardiogram(Ergostik,GerathermMedicalAG,
Geschwenda,Germany).Afterawarmuploadof20Wattsfortwominutes,15Wattsincre-
mentswereappliedeachminute,uptoexhaustion.Maximaloxygenconsumption(VO2peak)
wascalculatedinthelast30secondsofthetest.Maximalaerobicpoweroutput(MAPinW)
wasdeterminedasthepowerdevelopedatthelatestaccomplishedworkload.
Metabolicexercisetest. Afterawholefastingnight,thewomenperformedanexercisetest
onacyclo-ergometerconnectedtotheanalyserforgasexchangemeasurements(VO and
2
VCO )andtotheHRmonitor.Thetestconsistedofaprogressivefive-tosix-minutesteady
2
stateworkloadcorrespondingto20%,30%,40%,50%,60%ofMAPasgenerallyusedtoindi-
vidualizetheincrementoftesting[13,17].VO ,VCO andHRwererecordedduringthelast
2 2
twominutesofeachstageinordertocalculatethesubstrateoxidationflowrates[34].
MaximalFatOxidation. Substrateoxidationwascalculatedfromthemeasurementofthe
respiratoryexchangeratio(RER=VCO /VO )todeterminewholebodysubstrateoxidation.
2 2
RERisthemostwidelyusedmethodfordeterminationoffuelutilization.Fatoxidationrates
werecalculatedfromthegasexchangemeasurementsaccordingtothenon-proteinrespiratory
quotienttechniqueusingthefollowingequation:Fat(mg.min-1)=-1.7012×VCO +1.6946×
2
VO (gasvolumeexpressedinml.min-1)[35].
2
TheMFOisthepointwherefatoxidationinducedbyincreasingworkloadreachesamaxi-
mum,followedbyadecreasewhenCHObecomesthepredominantfuel.Thecorresponding
HRexpressedasbeatsperminute(bpm)atMFOintensitywasrecordedindividuallyandthen
appliedtocontroltheintensityofexercisetraininginG1(LIPOXmax).
Statisticalanalysis
Priorsamplesizecalculation. TheprimaryoutcomemeasurewastheindividualFM
changefromtheinclusiontotheendofthefollow-up,fivemonthslater(Δ ,inkg).Tothe
M5-M0
bestofourknowledge,LIPOXmaxintervention,sustainedoverfivemonths,hadneverbeen
comparedtootherPAtrainingprogramsinapopulationofyoungoverweightorobese
women;thusitwasnotpossibletouseanexpectedeffectvalueinsamplesizecalculation.Asa
consequence,ourRCTwasdesignedtodetectaminimalFMdifferenceof1.5kg(standard
deviation:±2.0kg)betweenG1andG2.Formultiplecomparisonpurposes,αriskwassetto
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1.67%usingBonferronicorrection(0.05:3),statisticalpower(1-β)to80%,inbilateral
hypothesis.
Undertheseconditions,38womenpergrouphadtoberecruitedandfollowedtosatisfythe
analysis.
Thisnumberwasraisedto42toanticipatea10%lossduetoprotocoldeviationorloss-to-
follow-up,leadingtotheenrolmentofatotalof126women.
Statisticalmethods. Dataweresummarizedbymean±standarddeviation(SD)or95%
confidenceinterval(95%CI),median(interquartilerange)andpercentages.Baselineinclusion
characteristicswerecomparedbetweengroupsusingone-wayANOVAorKruskal-Wallisnon
parametrictestforquantitativevariables,orusingChi2testorFisherexacttestforqualitative
variables,asappropriate.Baselineexercisetestsatinclusionwerecomparedbetweengroups
usingone-wayANOVAorKruskal-Wallisnonparametrictest,asappropriate.Changesin
anthropometriccharacteristicswerecomparedbetweengroupsusingone-wayANOVAor
Kruskal-Wallisnon-parametrictest,asappropriate,post-hocanalysisbeingperformedwith
Student-Ttests.RepeatedANOVAmeasuresallowedestimatingtimeeffect(M0-M3-M5),
(cid:4)
groupeffect(G1-G2-G3)andtheinteractiontime group.Wilcoxonrank-sumtestwasusedto
analysethedifferencesbetweenG1andG2.
Theprimaryoutcomeandtheotherfive-monthchangeswereanalyzedbetweenM5and
M0withinthegroupofsubjectsforwhomthesedatawereavailable.Thelongitudinalevolution
ofmetabolicparameterswasanalyzedforthesubjectsforwhomtheM0,M3andM5datawere
complete.Missingobservationswereexcluded.Exceptfortheaforementionedposthocanaly-
1
sis,thesignificancelevelwassetto5%.AnalyseswerecarriedoutusingSAS version9.2(SAS
InstituteInc.,Cary,NC,USA).
Results
Selectionofparticipants
TheLIPOXmax–Réunionflowchartdepictingthedistributionoftheparticipantsthroughout
theRCTispresentedinFig1.Ofthe156womeneligibleforthestudy,136wereenrolledand
randomizedbetweenNovember2011andApril2012.Ofthese,109subjectsweresubsequently
followed-upfivemonthsbetweenDecember2011andSeptember2012.Theywereassessedat
M0andM5(80.1%ofallrandomisedsubjects),andamongthem,103hadsatisfiedthecom-
pleteprotocolwithM0,M3andM5evaluations(75.7%ofallrandomisedsubjects).Noselec-
tionbiaswasobservedbetweenrandomizedparticipantsandnon-participants,regardlessof
thedefinitionofparticipationused(subjectsassessedatM0-M5,oratM0-M3-M5).
Baselinecharacteristics
ThephysicalcharacteristicsofsubjectsarepresentedinTable1.Womenwereagedonaverage
30yearsold.Morethanthree-quartersofthemwereobese(BMI(cid:1)30kg/m²)and86.6%hada
highwaistcircumferenceaccordingtotheNCEP/ATP-IIIthresholds.
Overall,thepercentageofFMwas47.1%andtheoneofFFM51.3%.Eightypercentwere
insulinresistant(HOMA-IRindex>2.5).MeanofMFOwasof153.4mg/min.AtM0,there
wasnodifferenceamongthethreegroupsinsocio-demographicandanthropometricdata
(Tables1and2).Therewerenodifferencesbetweensubjectswhodroppedoutandsubjects
whoparticipatedinallofthelongitudinalstudy,whichcoulddistortthebasiccharacteristics
(Fig1).Analysesofbiasofselectionareavailableassupportinginformation;seeS1–S4Tables.
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Fig1.LIPOXmaxRéunionFlowchart.
doi:10.1371/journal.pone.0139246.g001
Implementationoftrainingprograms
ForG1andG2,PAwaslevelledonthemaximalandmetaboliccardiorespiratoryvalues.To
obtainthesameenergyexpenditurebetweeneachgroup(20kJ.kgFFM-1),G1trainingsessions
werelongerindurationthanthoseforG2(53minvs.37min,p<0.001).Theintensityofexer-
cisewaslowerforG1thanforG2(45%vs.60%VO2max;119vs.140bpm;42vs.76Watts;
p<0.001,respectively).
G3womenpractisedonaveragetwodifferenttypesofexercise.TheexaminationofthePA
bookletsrevealedthat80.6%ofthewomenpractisedwalking,45.2%fitnessorgymnastics,
48.4%outdoorbiking,29.0%dancing(Zumba),19.4%swimmingand12.9%indoorbiking.
TheweeklyaveragenumberofPAsessionswas3.4(±0.9SD,min-max:0.8–4.7).Theweekly
averagetimespentonphysicalexerciseswas197.7minutes(±67.5min.SD,min-max:48.6–
350.2min.).Self-perceivedintensityreportedusingtheBorgscalerangedfromthreetofive.
Changesinanthropometricandbodycompositionparameters
AnthropometricandbodycompositionparametersweremeasuredbyDXAatM0andM5.
Accordingly,theevolutionofDXAmeasureswereanalysedforthe109subjectswhohadfully
completedM5data.ResultsaresummarizedinTable3.
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Table1. BaselineinclusioncharacteristicsforLIPOXmax-Réunionrandomizedcontrolledtrialparticipants.
Allgroups G1:LIPOXmax G2:60%VO2max G3:GPPathome p-value
N=136 N=46 n=45 n=45
Socio-demographic
characteristics
Age(years) 30.1±5.6 30.5±5.9 29.0±4.9 30.9±5.8 0.186*
Schoollevel:
Secondaryschool(pupilsfrom10 8.8% 15.2% 8.9% 2.2% 0.134*
to15)
Upperforms(pupilsfrom15to18) 46.3% 47.8% 37.8% 53.3%
A-levelorHigherschool 44.9% 37.0% 53.3% 44.4%
Numberofchildrenathome† 1.0(1.0–2.0) 2.0(1.0–2.0) 1.0(1.0–2.0) 2.0(1.0–2.0) 0.167*
Numberofchildren‡ 2.0(1.0–2.0) 2.0(1.0–3.0) 1.0(1.0–2.0) 2.0(1.0–3.0) 0.181*
RecipientofCMU 64.0% 69.6% 62.2% 60.0% 0.609
Livinginacouple 51.5% 54.3% 42.2% 57.8% 0.300
Anthropometriccharacteristics
Height(cm) 161.5±5.8 162.6±4.6 160.6±6.6 161.4±6.1 0.263
Weight(kg) 86.6±11.6 88.2±11.5 85.5±12.1 86.1±11.5 0.518
BMI(kg/m²) 33.1±3.5 33.3±3.8 33.1±3.5 33.0±3.3 0.950*
<30kg/m² 24.3% 21.7% 24.4% 26.7% 0.860
(cid:1)30kg/m² 75.7% 78.3% 75.6% 73.3%
Waistsize(cm) 97.9±9.0 98.7±9.4 96.3±8.5 98.8±8.9 0.342
<88cm 12.5% 6.5% 17.8% 13.3% 0.256*
(cid:1)88cm 87.5% 93.5% 82.2% 86.7%
Hips(cm) 121.0±8.3 121.0±8.5 121.1±9.3 121.0±7.2 0.996
ReportWaist/Hips 0.8±0.1 0.8±0.1 0.8±0.1 0.8±0.1 0.302
ReportWaist/Hips: <0.9 89.0% 87.0% 88.9% 91.1% 0.941*
(cid:1)0.9 11.0% 13.0% 11.1% 8.9%
Fatmass(kg) 39.9±7.9 40.2±7.8 40.2±8.5 39.3±7.4 0.819
Fatmass(%) 47.1±3.8 46.6±3.8 47.9±4.0 46.7±3.6 0.195
Anthropometriccharacteristics
TroncalFatMass(kg) 18.6±4.6 18.8±5.0 18.6±4.4 18.3±4.6 0.885
AndroidFatMass(kg) 3.4±1.0 3.4±0.9 3.4±1.0 3.4±1.0 0.933
GynoidFatMass(kg) 7.0±1.5 7.0±1.4 7.2±1.8 6.9±1.3 0.542
FatFreeMass(kg) 44.2±4.8 45.4±5.0 42.9±4.3 44.3±5.0 0.059*
FatFreeMass(%) 51.3±3.6 51.8±3.6 50.6±3.8 51.7±3.4 0.206
TroncalFatFreeMass(kg) 18.5±2.3 19.0±2.4 17.9±1.9 18.6±2.5 0.051
AndroidFatFreeMass(kg) 2.9±0.4 3.0±0.4 2.8±0.3 3.0±0.4 0.050
GynoidFatFreeMass(kg) 6.9±0.9 7.1±0.8 6.8±0.9 6.9±0.9 0.234
Bloodpressure
Systolicbloodpressure(mmHg) 117.0±9.9 117.8±9.2 115.7±11.4 117.5±9.1 0.565
Diastolicbloodpressure(mmHg) 74.4±8.5 74.8±8.8 74.3±8.7 74.3±8.1 0.950
Lipidprofile
TotalCholesterol(mmol/L) 4.5±0.8 4.5±0.8 4.5±0.9 4.6±0.8 0.890
LDLCholesterol(mmol/L) 2.8±0.7 2.8±0.8 2.8±0.7 2.8±0.7 0.929
HDLCholesterol(mmol/L) 1.2±0.3 1.3±0.3 1.2±0.3 1.3±0.3 0.773
HDL-C/LDL-Cratio 0.48±0.21 0.49±0.25 0.47±0.17 0.49±0.19 0.699*
Triglycerides(mmol/L) 1.1±0.5 0.9±0.3 1.1±0.6 1.2±0.6 0.297*
Glucoseprofile
(Continued)
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Table1. (Continued)
Allgroups G1:LIPOXmax G2:60%VO2max G3:GPPathome p-value
N=136 N=46 n=45 n=45
HbA1c(%) 5.5±0.3 5.5±0.4 5.5±0.3 5.4±0.3 0.363*
Fastingplasmaglucose(mmol/L) 5.0±0.5 5.0±0.4 4.9±0.5 4.9±0.5 0.535*
Insulin(mUI/L) 20.0±11.3 20.8±9.6 21.5±13.7 17.6±9.8 0.086*
HOMA-IRindex 4.5±2.8 4.7±2.5 4.8±3.5 3.9±2.2 0.141*
Insulinresistant(HOMA-IR 80.0% 84.4% 80.0% 75.6% 0.574
index>2.5)
†Dataaremediansandinterquartilerange.
‡Dataaremediansandinterquartilerange.Otherwise,dataaremeans±SDorpercentages.CMU:universalhealthcoverage.
HOMA-IRindex:HomeostasisModelAssessmentestimatedinsulinresistanceindex.p-valuesrefertocomparisonbetweenthethreegroupsbyone-way
ANOVAorKruskal-Wallisnonparametrictests(*)forquantitativevariables,andbyChi2testorFisherexacttests(*)forqualitativevariables.
doi:10.1371/journal.pone.0139246.t001
AtM5,eachgroup(G1,G2,G3)exhibitedasignificantdecreaseintotalbodyweightover
time(intra-groupdifferences:-5.0±0.6;-5.4±0.7;-3.5±0.9kgrespectively,p<0.001),BMI
(-1.8±0.2;-2.1±0.3;-1.4±0.3kg/m²,p<0.001)andFM(-4.1±0.5;-4.7±0.5;-3.5±0.8kg,
p<0.001).However,therewerenosignificantinter-groupdifferenceswithrespecttothese
threeparameters(p=0.172;p=0.194;p=0.135,respectively).Ofnote,FMdecreasedsignifi-
cantlyinthetotalbodyandmainbodysegmentsinthethreegroups:-2.4±0.4vs-3.0±0.4vs
-2.1±0.4kginthetrunk,-0.5±0.1vs-0.6±0.1vs-0.4±0.1kgintheandroidarea,-0.8±0.1vs
-0.8±0.1vs-0.7±0.1kginthegynoidareaforG1,G2,G3,respectively.Incontrast,FFM
Table2. BaselineexercisetestsatinclusionforLIPOXmax-Réunionrandomizedcontrolledtrialparticipants.
Allgroups G1:LIPOXmax G2:60%VO2max G3:GPPathome p-value
n=136 n=46 n=45 n=45
Maximalexercisetest
VO2max(L/min) 1.9±0.3 1.9±0.3 1.8±0.2 1.9±0.3 0.645
VO2max(mL/min/kgFFM) 42.5±6.3 42.0±6.7 43.3±6.2 42.3±6.1 0.632*
HRmax(bpm) 173.0±11.3 170.5±10.1 176.1±12.0 172.5±11.3 0.072*
RER 1.1±0.1 1.1±0.1 1.1±0.1 1.1±0.1 0.585*
Wmax(W) 136.0±19.9 137.2±21.6 132.6±21.1 138.4±16.2 0.429*
Metabolicexercisetest
HRatLIPOXmax(bpm) 120.9±13.6 118.5±11.6 121.3±13.7 123.0±15.3 0.263*
WatLIPOXmax(W) 43.4±12.1 41.9±11.9 42.8±12.0 45.6±12.5 0.397*
WatLIPOXmax(%Wmax) 32.2±8.3 30.9±8.7 32.5±8.4 33.1±7.6 0.402*
BorgatLIPOXmax(6–20) 11.2±1.1 11.0±1.2 11.2±1.0 11.4±1.1 0.089*
VO2atLIPOXmax(ml/min) 843.5±142.3 844.2±113.5 825.9±154.6 860.3±156.5 0.522
VO2atLIPOXmax(%VO2max) 45.7±8.3 45.2±7.4 45.3±9.6 46.8±8.0 0.621
MaximalLipidOxidation
MFO(mg/min) 153.4±42.9 151.6±36.7 143.9±38.4 164.6±50.6 0.135*
MFO(mg/min/kgFFM) 3.5±1.0 3.4±0.9 3.4±1.0 3.7±1.0 0.170*
Dataaremeans±SD.FFM:FatFreeMass.HR:HeartRate.RER:RespiratoryExchangeRatio.W:Power.MFO:MaximalFatOxidation.p-valuesreferto
comparisonsbetweenthethreegroupsbyone-wayANOVAorKruskal-Wallisnonparametrictests(*).
doi:10.1371/journal.pone.0139246.t002
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Table3. Five-monthchangesinanthropometricandbodycompositioninLIPOXmax-Réunionrandomizedcontrolledtrialparticipants.
G1:LIPOXmax G2:60%VO2max G3:GPPathome p-value G1vsG2 G1vsG3 G2vsG3
n=33 n=39 n=37
DXAcharacteristics
Weight(kg) -5.0(-6.5to-3.4) -5.4(-6.8to-4.0) -3.5(-5.0to-2.1) 0.172 - - -
BMI(kg/m²) -1.8(-2.4to-1.2) -2.1(-2.7to-1.6) -1.4(-2.0to-0.9) 0.194 - - -
FatFreeMass(kg) -0.8(-1.2to-0.3) -0.7(-1.1to-0.3) 0.0(-0.4to0.4) 0.026 0.820 0.010 0.032
FatFreeMass(%) 2.2(1.3to3.1) 2.7(1.9to3.6) 2.6(1.7to3.4) 0.703 - - -
FatMass(kg) -4.1(-5.4to-2.7) -4.7(-5.9to-3.5) -3.5(-4.8to-2.3) 0.135* - - -
FatMass(%) -2.3(-3.3to-1.4) -2.9(-3.8to-2.0) -2.7(-3.6to-1.8) 0.663 - - -
TruncalFatMass(kg) -2.4(-3.3to-1.5) -3.0(-3.8to-2.2) -2.1(-2.9to-1.3) 0.245 - - -
AndroidFatMass(kg) -0.5(-0.6to-0.3) -0.6(-0.7to-0.4) -0.4(-0.5to-0.2) 0.169 - - -
GynoidFatMass(kg) -0.8(-1.0to-0.5) -0.8(-1.1to-0.6) -0.7(-0.9to-0.4) 0.441* - - -
TruncalFatFreeMass(kg) -0.5(-0.9to-0.1) -0.7(-1.1to-0.4) -0.2(-0.6to0.1) 0.148 - - -
AndroidFatFreeMass(g) -95.1(-158.3to-31.8) -112.1(-171.0to-53.2) -11.9(-71.6to47.9) 0.046 0.702 0.059 0.020
GynoidFatFreeMass(g) -139.5(-268.2to-10.8) -157.3(-277.2to-37.3) 39.7(-81.8to161.3) 0.100* - - -
DataarechangesfromM0toM5(M5minusM0):mean(95%confidenceinterval).M5:fifthmonthofintervention.pvaluesreferstocomparisonbetween
thethreegroupsbyone-wayANOVAmodelorKruskal-Wallisnonparametrictest(*).Ifp<0.05,post-hocanalysiswasperformedwithStudent’stestto
comparegroupstwo-by-twoatp=0.0167significancelevelaccordingtoBonferroni’smethod.
doi:10.1371/journal.pone.0139246.t003
evolutionovertimewasslightlydifferentbetweengroups(p=0.026)anddecreasedforG1and
G2(-0.8±0.2;-0.7±0.2kg,respectively)whileitremainedstableforG3.Bonferronicorrection
revealedthatchangeinFFMonlydifferedbetweenG1andG3(p=0.010).Asshownbythe
wide95%CIs,overtimethethreegroupsexhibitedalargevariabilityinFMevolution(andon
abroaderspectrum,forallbodycharacteristics)inresponsetothethreedifferent
interventions.
Changesinmetaboliccharacteristics
Outofthe109subjectsassessedatM5,theanalysesofmetaboliccharacteristicswereper-
formedforthe103subjectswhohadacompletelongitudinalfollow-up(M0,M3andM5).
ThesedataaresummarizedinTable4.Posthocanalyseshavebeenperformedtocompare
groupstwobytwo(Tables4and5).
Totalcholesterol,triglyceridesandFPGlevelswerestableovertime.HDL-C/LDL-Cratio
improvedinthethreegroupsthroughouttheinterventionwithdifferentpatterns(rapidbut
slightandtransientresponseinG1,increasingresponsewithtimeinG2andG3).HbA1c
decreasedovertimewithoutsignificantinter-groupdifferences.
Glucosecontrolimprovedthroughouttheintervention,thepercentageofinsulin-resistant
women(HOMA-IRindex>2.5)fallingfrom80%to60%betweenM0andM5.Insulinlevel
andHOMA-IRindexdecreasedineachgroup(overalltime-by-groupinteractionp=0.014,
p=0.011,respectively).However,thereductionsininsulinandHOMA-IRindexwere
(cid:4)
markedlylargerforG1whencomparedtoG3(G1 G3time-by-groupinteractions,p=0.004
forinsulinandp=0.002,forHOMA,respectively).
Inlinewiththeseresults,MFOexpressedinmg.min-1increasedsignificantlyovertimein
eachgroup(overalltime-by-groupinteraction,p<0.001).Asexpectedfromtheabovedatathis
changewaslargerforG1thanforG3(time-by-groupinteractionG1(cid:4)G3,p<0.001)whileit
(cid:4)
wasalsosignificantbetweenG2andG3(time-by-groupinteractionG2 G3,p=0.004)butnot
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