Physical activity, total and regional obesity:
ROBERT ROSS and IAN JANSSEN
School of Physical and Health Education, Queen’s University, Ontario, CANADA
ROSS, R., and I. JANSSEN. Physical activity, total and regional obesity: dose-response considerations. Med. Sci. Sports Exerc., Vol.
33, No. 6, Suppl., 2001, pp. S521–S527. Purpose: This review was undertaken to determine whether exercise-induced weight loss was
associated with corresponding reductions in total, abdominal, and visceral fat in a dose-response manner. Methods: A literature search
(MEDLINE, 1966–2000) was performed using appropriate keywords to identify studies that consider the influence of exercise-induced
weight loss on total and/or abdominal fat. The reference lists of those studies identified were cross-referenced for additional studies.
Results: Total fat. Review of available evidence suggested that studies evaluating the utility of physical activity as a means of obesity
reduction could be subdivided into two categories based on study duration. Short-term studies (?16 wk, N ? 20) were characterized
by exercise programs that increased energy expenditure by values double (2200 vs 1100 kcal·wk-1) that of long-term studies (?26 wk,
N ? 11). Accordingly, short-term studies report reductions in body weight (?0.18 vs ?0.06 kg·wk-1) and total fat (?0.21 vs ?0.06
kg·wk-1) that are threefold higher than those reported in long-term studies. Moreover, with respect to dose-response issues, the evidence
from short-term studies suggest that exercise-induced weight loss is positively related to reductions in total fat in a dose-response
manner. No such relationship was observed when the results from long-term studies were examined. Abdominal fat. Limited evidence
suggests that exercise-induced weight loss is associated with reductions in abdominal obesity as measured by waist circumference or
imaging methods; however, at present there is insufficient evidence to determine a dose-response relationship between physical activity,
and abdominal or visceral fat. Conclusion: In response to well-controlled, short-term trials, increasing physical activity expressed as
energy expended per week is positively related to reductions in total adiposity in a dose-response manner. Although physical activity
is associated with reduction in abdominal and visceral fat, there is insufficient evidence to determine a dose-response relationship. Key
Words: PHYSICAL ACTIVITY, OBESITY, ABDOMINAL FAT, VISCERAL FAT, WEIGHT LOSS, DOSE-RESPONSE
evidence also suggests that an increase in physical activity
(exercise) without caloric restriction is a useful strategy for
reducing obesity, in particular, abdominal and visceral obe-
sity (38,39,40,44). This review was undertaken to determine
whether exercise-induced weight loss is associated with
corresponding reductions in total, abdominal, and visceral
fat in a dose-response manner.
The format of this review follows the guidelines set forth
in the recent National Institutes of Health, National Heart,
Lung, and Blood Institute (NHLBI) document (31). As such,
Section A (Current Knowledge) consists of a series of
Evidence Statements followed by a brief rationale. Follow-
ing each Evidence Statement is an Evidence Category that is
generally consistent with the criteria established by the
Expert Panel (31).
To consider the influence of varying levels of physical
activity on total and abdominal obesity, a MEDLINE search
t is generally accepted that a decrease in daily physical
activity has contributed to the increased prevalence of
obesity worldwide (13,18,31,47). Accordingly, limited
(1966–2000) was performed using “weight loss” and “exer-
cise” as keywords. The reference lists of those studies identi-
fied were then reviewed for additional studies. Appropriate
studies were identified using the following inclusion criteria:
1. The subjects participating in the exercise group either
had to consume an isocaloric diet for the duration of the
study, thereby ensuring that the negative energy balance
observed (e.g., significant reduction in total and/or ab-
dominal fat) was induced by the increase in physical
activity or the subjects in the physical activity (exercise)
group were instructed not to change their diet (eating)
habits and thus, in theory, a negative energy balance
would be induced by an increase in exercise.
2. The subjects were overweight or obese, and thus the
mean BMI values had to be greater than 25.0 kg·m-2
(31). For studies not reporting BMI values, the mean
percent body fat had to be greater than 20% in men and
greater than 33% in women, values that correspond to
a BMI of 25.0 kg·m-2(15).
3. That measurements of whole-body or abdominal fat
were obtained using established methods (e.g., under-
water weighing, duel energy x-ray absorptiometry,
computed tomographic scan, magnetic resonance im-
aging (MRI), and waist circumference).
4. That the authors reported the caloric expenditure of
the exercise or provided the information required to per-
mit estimation of oxygen cost and caloric expenditure
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2001 by the American College of Sports Medicine
Submitted for publication January 2001.
Accepted for publication March 2001.
Proceedings for this symposium held October 11–15, 2000, Ontario,
39. ROSS R., J. A. FREEMAN, and I. JANSSEN. Exercise alone is an
effective strategy for reducing obesity and related comorbidities.
Exerc. Sport Sci. Rev. 28:65–70, 2000.
40. ROSS, R., and I. JANSSEN. Is abdominal fat preferentially reduced in
response to exercise-induced weight loss? Med. Sci. Sports Exerc.
41. SCHWARTZ, R. S. The independent effects of dietary weight loss and
aerobic training on high density lipoprotein (HDL) and apolipopro-
tein A-I concentrations in obese men. Metabolism 36:165–171, 1987.
42. SCHWARTZ, R. S., W. P. SHUMAN, V. LARSON, et al. The effect of
intensive endurance exercise training on body fat distribution in
young and older men. Metabolism 40:545–551, 1991.
43. SMUTOK, M. A., C. REECE, P. F. KOKKINOS, et al. Aerobic versus strength
training for risk factor intervention in middle-aged men at risk for coro-
nary heart disease (CHD). Metabolism 42:177–184, 1993.
44. SOPKO, G., A. S. LEON, D. R. JACOBS, et al. The effects of exercise
and weight loss on plasma lipids in young obese men. Metabolism
45. TARNOPOLSKY, L. J., J. D. MACDOUGALL, S. A. ATKINSON,
for endurance exercise. J. Appl. Physiol. 68:302–308, 1990.
46. WELTMAN, A., S. MATTER, and B. A. STAMFORD. Caloric restriction
and/or mild exercise: effects on serum lipids and body composi-
tion. Am. J. Clin. Nutr. 33:1002–1009, 1980.
47. WILLIAMSON, D. F., J. MADANS, R. F. ANDA, J. C. KLEINMAN, H. KAHN,
and T. BYERS. Recreational physical activity and ten-year weight
change in a US national cohort. Int. J. Obes. 17:279–286, 1993.
48. WOOD, P. D., M. L. STEFANICK, D. M. DREON, et al. Changes in
plasma lipids and lipoproteins in overweight men during weight
loss through dieting as compared with exercise. N. Engl. J. Med.
EXERCISE AND OBESITY REDUCTIONMedicine & Science in Sports & Exercise?