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Health-Related Benefits of Exercise Training with a Sauna Suit: A Randomized, Controlled Trial

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Purpose: Worldwide, the prevalence of overweight and obesity has more than doubled in adults. This epidemic is associated with many cardiovascular and metabolic disorders. Training strategies exist for weight reduction, one of which is heat stress. Evidence has shown that exercise combined with heat therapy provides cardiovascular health benefits. Research is lacking on the use of a heat stress on health parameters for overweight or obese individuals. The purpose of this study was to quantify the effect of health-related benefits associated with exercise training using a sauna suit in a cohort of overweight and obese individuals. Methods: Overweight or obese, sedentary, but low risk men and women (n=45) were randomized to the non-exercise control group or one of the two training groups. Exercise training was five days a week for eight-weeks. Monday, Wednesday, and Friday were 45 minutes long training sessions at a moderate intensity based on an individual's heart rate reserve (HRR). Tuesdays and Thursdays were 30 minute long spin classes at a vigorous intensity based on an individual's HRR and were instructed by the principle investigator. Results: 45 men and women completed the study. After eight-weeks, V̇ O2max increased significantly (p<0.05) in the sauna suit with exercise group (ESS) when compared to the exercise alone (E) and control groups. Repeated measures ANOVA also showed a significant (p<0.05) improvement in body mass, body fat, blood glucose, RMR, and fat oxidation in the ESS group when compared to the E and control groups. Conclusions: A sauna suit in conjunction with exercise: 1) elicited significantly greater improvements in V̇ O2max, and 2) significantly improved obesity associated health parameters, which include: body mass, body fat, blood glucose, RMR, and fat oxidation. The novel findings of the present study suggest that a portable heat stress may improve health parameters in overweight or obese.
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[Year]
21
Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
Sponsored by:
Exercise and Sport Science Program
Western State Colorado University
Health-Related Benefits of Exercise Training with a Sauna Suit:
A Randomized, Controlled Trial
Devan E. Haney1, Abigail Owen1, Jennifer S. Fargo1, Samantha N. Harrison1, Margaret K. Chevalier1,
Christina A. Buchanan1, Lance C. Dalleck1
1High Altitude Exercise Physiology Program, Western State Colorado University, Gunnison, CO, USA
Abstract
Purpose: Worldwide, the prevalence of overweight and obesity has more than doubled in adults. This
epidemic is associated with many cardiovascular and metabolic disorders. Training strategies exist for
weight reduction, one of which is heat stress. Evidence has shown that exercise combined with heat
therapy provides cardiovascular health benefits. Research is lacking on the use of a heat stress on
health parameters for overweight or obese individuals. The purpose of this study was to quantify the
effect of health-related benefits associated with exercise training using a sauna suit in a cohort of
overweight and obese individuals. Methods: Overweight or obese, sedentary, but low risk men and
women (n=45) were randomized to the non-exercise control group or one of the two training groups.
Exercise training was five days a week for eight-weeks. Monday, Wednesday, and Friday were 45
minutes long training sessions at a moderate intensity based on an individual’s heart rate reserve
(HRR). Tuesdays and Thursdays were 30 minute long spin classes at a vigorous intensity based on an
individual’s HRR and were instructed by the principle investigator. Results: 45 men and women
completed the study. After eight-weeks, V̇O2max increased significantly (p<0.05) in the sauna suit with
exercise group (ESS) when compared to the exercise alone (E) and control groups. Repeated measures
ANOVA also showed a significant (p<0.05) improvement in body mass, body fat, blood glucose, RMR,
and fat oxidation in the ESS group when compared to the E and control groups. Conclusions: A sauna
suit in conjunction with exercise: 1) elicited significantly greater improvements in V̇O2max, and 2)
significantly improved obesity associated health parameters, which include: body mass, body fat, blood
glucose, RMR, and fat oxidation. The novel findings of the present study suggest that a portable heat
stress may improve health parameters in overweight or obese.
Key Words: Cardiorespiratory fitness, Cardiovascular disease, Heat Therapy, Weight loss
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
INTRODUCTION
In recent years, obesity has become one of
the most important health concerns for
advancing and developing countries1.
Worldwide, obesity has contributed to
diabetes, cardiovascular disease (CVD), and
renal insufficiency and is associated with
morbidity and mortality. CVD is the leading
cause of death, accounting for 17.3 million
deaths per annum, a figure that is projected
to grow to more than 23.6 million by
203015. Management of risk factors, that
are not hereditary, coupled with good
nutrition, weight management, and physical
activity can be used as preventative
measures in avoiding CVD at an early age or
later in life. It has been estimated that 80
percent of premature heart disease can be
avoided through positive modification of
CVD risk factors15. In particular, regular
physical activity has been shown to confer a
myriad of health benefits, including the
prevention of numerous CVD risk factors
such as hypertension (HTN), obesity, type 2
diabetes (T2DM), and dyslipidemia21. In
addition, present research has
demonstrated that systemic thermal
therapy by regular administration of heat
through a variety of methodologies, such as
saunas, can also induce a number of
advantageous responses in terms of
cardiovascular health. Chronic exposure to
heat stress has been reported to be
associated with a reduced risk of CVD and
mortality from all-causes14. Additionally,
Krause and colleagues13 reported that heat
therapy reduces fasting glycemia, glycated
hemoglobin, body weight, and adiposity.
There is also evidence that exercise, in
conjunction with heat therapy, provides
cardiovascular health benefits. For instance,
it has been demonstrated that three weeks
of post-exercise sauna bathing elicits an
improvement in cardiorespiratory fitness,
most likely due to an increase in plasma
volume18. Finally, heat can also be used to
enhance the magnitude of excess-post
oxygen consumption (EPOC) resulting in
raised metabolism and weight loss5.
Recent research has investigated the effects
of exercise training in a sauna suit and the
impact it has on EPOC and other health
parameters. A study by Van de Velde et al.20
used 12 well-trained participants in a six-
week training program while wearing a
sauna suit. The study found significant
improvements in cardiometabolic risk
factors such as body fat percentage, systolic
and diastolic blood pressure, triglycerides,
HDL cholesterol, and maximal oxygen
uptake. The study supports that exercise
prescriptions involving a sauna suit may
improve cardiovascular health,
cardiorespiratory fitness, and reduction of
CVD risk factors, however additional
research is lacking on this topic.
Acclimatization to heat through systemic
alterations include: a decreased sweating
threshold, reduced threshold for cutaneous
vasodilation, and greater skin blood flow at
a given temperature, all of which can be
beneficial adaptations for exercise training3.
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Exercise and Sport Science Program
Western State Colorado University
Training programs with modest weight
reduction (approximately 10 percent or
less) in patients with obesity-associated
medical complications has been shown to
be beneficial for obese individuals with non-
insulin dependent diabetes mellitus, HTN,
and hyperlipidemia7. Additionally,
abdominal obesity is associated with a
pathological accumulation of visceral fat,
resulting in the production of adipokines
that lead to insulin resistance and chronic
inflammation that underlies obesity related
comorbidities12. A recent study by Khoo et
al.11 compared the effects of diet- or
exercise induced weight loss on chemrin,
adiponectin, insulin resistance, and
inflammation in obese men. The study
found that exercise induced fat mass loss
was a more effective strategy than dieting
for improving adipokines profile, insulin
resistance, and systemic inflammation.
Research is lacking on combining heat stress
to a training program to improve health
parameters in overweight and obese
individuals. To our knowledge this is the
first, randomized, controlled study to have
investigated the effects of exercise training
with a sauna suit on performance and
health outcomes in an overweight/obese
population. It is plausible that exercise
training with a sauna suit may provide
overweight and obese individuals and
fitness professionals with a more practical
and portable heat therapy alternative when
compared to other thermal treatments.
Therefore, the purpose of this study was to
quantify the effect of health-related
benefits associated with exercise training
using a sauna suit in a cohort of overweight
and obese men and women. It was
hypothesized that exercise training with a
sauna suit would result in significantly
greater weight loss and improved
cardiovascular health when compared to
the exercise alone.
METHODS
Participants
45 overweight or obese participants (men
and women) 18 to 60 years of age were
recruited to perform an 8 week exercise
training intervention. Inclusion criteria for
participants consisted of overweight or
obese (BMI 25 kg/m2 and BMI 40
kg/m2), sedentary individuals who were
low-to-moderate risk as defined by the
American College of Sports Medicine
(ACSM) guidelines16, with body fat
percentages that were suboptimal.
Nonessential fat, above the minimal
amount, is generally accepted as 10-22
percent for men and 20-32 percent for
women for good health16. Anything fat
beyond this percent is considered
suboptimal. Exclusion criteria included
those who were high risk due to
cardiovascular, pulmonary, and/or
metabolic disease and those who did not
have a BMI ≥ 25 kg/m2 or a BMI ≥ 40 kg/m2.
In addition, a PAR-Q and Health History
Questionnaire were administered to screen
any high-risk individuals. Prior to baseline
testing, participants signed a written
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Western State Colorado University
informed consent. The Institutional Review
Board at Western State Colorado University
approved the study [HRC2017-01-01R29].
Randomization and Intervention
The intervention consisted of three groups:
exercise with a sauna suit (ESS), exercise
alone (E), and the control. Participants were
assigned either the ESS provided by Kutting
Weight (Kutting Weight, Van Nuys, CA) or
the E group via computerized
randomization after being matched for sex
and body fat percentage with another
participant. The control group was a cohort
of individuals who met the inclusion criteria
and came only for health parameter
measurements but were not asked to
workout or change their daily behaviors.
Refer to Figure 1. Both the exercise in the
sauna suit and exercise groups performed
similar frequency, duration, and intensity
for their exercise prescription. The
intervention consisted of five exercise bouts
per week with three days at a moderate
intensity for 45 minutes and two days at a
vigorous intensity for 30 minutes. Refer to
Figure 1. Additionally, each participant was
able to miss 10 days of training without
being eliminated from the study and were
asked to record each workout in an exercise
training log. Participants were also
instructed to maintain their usual dietary
habits and not perform other exercises or
physical activity outside the prescribed
study. Modalities prescribed for moderate
intensity days varied from the elliptical,
rower, and treadmill depending each
participant’s limitations and fitness level.
The two days per week of vigorous exercise
were met by attending a spin class led by
the principal researcher, where heart rate
was monitored to assure that correct
intensities were performed. Exercise
progression throughout the 8-week
intervention was calculated using a heart
rate reserve range that increased weekly to
reach ASCM guidelines16 for overweight and
obese adults. Refer to table 2. Finally, all
exercise prescriptions were completed in
the Mountaineer Field House in Gunnison,
Colorado (2346.96m).
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Western State Colorado University
Figure 1. Flow chart of experimental procedures and intervention.
Table 1. 8-week exercise progression: Monday, Wednesday, Friday- elliptical, rower, and
treadmill; Tuesday, Thursday: spin bike
Monday
Tuesday
Wednesday
Thursday
week
min
intensity*
min
intensity*
min
intensity*
min
intensity*
min
intensity*
1
30
40-45
20
60-65
30
40-45
20
60-65
30
40-45
2
35
45-50
25
60-65
35
45-50
25
60-65
35
45-50
3
40
50-55
30
65-70
40
50-55
30
65-70
40
50-55
4
45
50-55
30
65-70
45
50-55
30
65-70
45
50-55
5
45
50-55
30
70-75
45
50-55
30
70-75
45
50-55
6
45
50-55
30
70-75
45
50-55
30
70-75
45
50-55
7
45
50-55
30
70-75
45
50-55
30
70-75
45
50-55
8
45
50-55
30
70-75
45
50-55
30
70-75
45
50-55
*intensity prescribed as % of heart rate reserve (HRR).
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
Experimental Design
Baseline, midpoint, and post-program
experimental testing procedures
Assessments of all primary and secondary
outcome variables were measured both
before and after the 8-week exercise
intervention. The primary outcome
variables consisted of weight, body
composition, fat metabolism, resting
metabolism, and anthropometric measures.
Secondary outcomes included: resting heart
rate (RHR), blood pressure (BP), VO2max,
fasting blood lipids and glucose. All
measurements were obtained following
standardized procedures outlined from
American Council on Exercise (ACE) and
ACSM guidelines16,19. Descriptions of
procedures for each measurement are
outlined below. All post program testing
was completed within 1 week after the 8-
week intervention. Additionally, a Physical
Activity Enjoyment Scale (PACES)
questionnaire10 was administered post
intervention to assess the intervention
group’s view of the exercise prescription.
Protocols
Anthropometric measurements
All participants were weighed to the
nearest 0.1 kg on a medical grade scale and
measured for height to the nearest 0.5 cm
using a stadiometer (Tanita, Tokyo, Japan).
Prior to these measurements individuals
were asked to remove shoes and wear light
clothing for pre/post assessments to ensure
accurate readings. Percent body fat was
assessed via skinfold. Skinfold thickness was
measured to the nearest ±0.5 mm using a
Lange caliper (Cambridge Scientific
Industries, Columbia, MD). A three-site
method was used for men and women,
standardizing all measurements to the right
side of the body. All measurements were
performed until two were within 10% of
each other. Body composition determined
from skinfold thickness measurements
correlates well (r = 0.07-0.09) with body
composition. Dr. Andrew Jackson and M. L.
Pollock provided the research that give a
value for body density and percent body fat
from skinfold and girth circumference
measurements. They found that once body
density is calculated, the level of body fat
can be determined using the Siri Equation16.
Waist circumference was determined using
a spring loaded-handle cloth tape (Creative
Health Products, Ann Arbor, MI) around the
narrowest point of the torso (below the
xiphoid process and above the umbilicus).
Three measurements were taken to insure
2 were within 0.5 mm of each other.
Resting metabolic rate and fat metabolism
Resting metabolic rate (RMR) was
measured via indirect calorimetry to
represent the amount of energy expended
by an individual at rest. Participants were
connected to the Oxycon mobile metabolic
system (CareFusion Respiratory Care, Yorba
Linda, CA) and were asked to rest quietly for
30 minutes before measurements
commenced. Participants were also asked
not to consume alcohol 24 hours prior to
the test, eat at least 4 hours prior to the
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
test, consume caffeine at least 3 hours prior
to the test, or consume nicotine 1 hour
prior to the test. A 10-minute test was
completed, with the first 5 minutes
discarded and the remaining 5 minutes
representing of RMR and fat oxidation.
Resting heart rate and blood pressure
measurement
When measuring RHR participants were
asked to remain seated quietly for 5
minutes in a chair with their feet flat on the
floor and an arm supported at heart level16.
RHR was obtained through palpation of the
radial artery recording the number of
heartbeats for 15 seconds and multiplying
said number by 4. BP was measured using a
sphygmomanometer (Medline, Mundelein,
IL) around the brachial artery and a
stethoscope was used to listen for Korotkoff
sounds, averaging 3 measurements
bilaterally for validity.
Maximal exercise testing
All participants performed a modified-
Balke, pseudo-ramp graded maximal
exercise test (GXT) pre- and post-program
on a motorized treadmill (Powerjog GX200,
Maine, USA). Depending on fitness level,
participants walked or jogged at a self-
selected pace. Grade increased every
minute by 1% until the participant reached
a point of volitional fatigue. Before each
GXT, the metabolic analyzer was calibrated
to meet the known gases concentrations of
14.01 ± 0.07% O2, 6.00 ± 0.03% CO2. Volume
calibration of the pneumotachometer was
done using a 3-Litre calibration syringe
system (Hans-Rudolph, Kansas City, MO,
USA). Gas exchange was measured during
the test using the Parvo Medics metabolic
cart (Parvo Medics, Sandy, Utah). During
the test, the participants wore a Polar heart
rate monitor (Polar, Lake Success, NY) and
measurements were taken every minute.
Exercise blood pressure was also measured
during the VO2max, using an arm cuff
(American Diagnostic Corporation,
Hauppauge, New York) and stethoscope
(Littmann, St. Paul, Minnesota). Participants
were asked to rate their rating of perceived
exertion (RPE) 10-point scale during the test
at the 45-second mark of each minute.
After testing, participants went through an
exercise cool-down until heart rate was
brought to resting. At completion of the
test, the last three 15 second increments
were averaged to represent the VO2max
value and the highest recorded HR was
considered the maximal HR.
Fasting blood lipids and glucose
Prior to blood analyses, participants were
asked to fast for 10-12 hours and not
consume caffeine. Upon arrival for
measurement, participants washed and
warmed their hands. Alcohol swabs were
then used to clean the finger that got
punctured. Lancets were used to puncture
the skin and a fingerstick sample was
collected using a heparin-coated 40 l
capillary tube. Blood was taken from the
fingerstick into the capillary tube without
milking the finger. Upon collection of blood,
the sample was immediately dispensed into
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
a test cassette for analysis in a Cholestech
LDX System (Alere Inc., Waltham, MA). The
Cholestech LDX machined measured for
low-density lipoprotein (LDL) cholesterol,
total cholesterol (TC), high-density
lipoprotein (HDL) cholesterol, triglycerides
(TG), and blood glucose (BG). Past studies
have supported that the Cholestech LDX
system has reliability with standard clinical
laboratory measurements of plasma lipids
and lipoproteins and meets the National
Cholesterol Education Program Adult
Treatment Panel III (NCEP-ATP) criteria for
accuracy and reproducibility.
Statistical analyses
Measurements were analyzed using the
Statistical Package for the Social Sciences,
Version 23.0 (IBM Corporation, Armonk,
NY). All variables were initially checked for
normality using the Kolmogorov-Smirnov
test and were found not to be significant (p
> 0.05). Measures of centrality and spread
are presented as mean ± standard deviation
(SD). Paired t-tests were utilized to
determine pre-post differences within each
group. One-way ANOVA were used to
compare changes in all primary and
secondary parameters between the sauna
suit group, exercise group and control
group from baseline to post-program. The
alpha level of statistical significance was set
at p<0.05 for all analyses.
RESULTS
For the present study, all analyses and data
in the results are for those individuals who
completed the eight-week intervention. At
baseline, the sauna suit with exercise and
exercise group did not differ significantly in
physical or physiological characteristics.
Refer to Table 2 for physical and
physiological characteristics of participants.
Both the E and ESS groups had great
adherence for the exercise progression
prescribed, with 28 of the 32 participants
completing the intervention and 13
participants completing pre and post
measurements for the control group. Four
participants dropped out during the study
for the following reasons: injury outside the
study (n=2), illness (n=1), and personal
reasons (n=1). It was also noted that during
the eight-week study, not a single
participant who received the sauna suit
intervention dropped out. Overall, there
was excellent adherence in both groups,
with each participant not missing more than
10 training sessions during the 8 week
intervention. Specifically, the ESS group
averaged 36/40 (90%) training sessions and
the E group averaged 34/40 (85%) training
sessions. The control group (n=13) was a
group of individuals who came into the
laboratory at Western State Colorado
University for health parameter
measurements. They were not prescribed
an intervention and were not asked to
workout, for this reason many of their
health parameters did not improve or got
worse. It is also noted that during the
present eight-week study, not a single
participant who received the sauna suit
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
intervention dropped out. This indicates the
sauna suit was not a factor when it came to
participant adherence. Additionally, the
PACES questionnaire was administered post
intervention and revealed that both the E
and ESS training group viewed the exercise
training prescription as enjoyable.
Health parameters with no significant
improvements after an eight week
intervention
After the eight week exercise training
intervention, the present study found no
significant changes in resting HR, HDL
cholesterol, LDL cholesterol, or triglycerides
for either the ESS or E group (p > 0.05). This
is reported in Table 2. Additionally, the
PACES questionnaire found no significant
difference between the ESS (85.7 6.3) and
E (84.7 4.5) group (p > 0.05).
Significant improvements with the ESS and E
groups compared to the control group
The ESS group showed significantly more
improvements in systolic BP (4.2 3.8
mmHg or ESS vs. -2.0 0.7 mmHg, control),
diastolic BP (3.2 0.7 mmHg vs. -2.6 2.4.7
mmHg, control), and total cholesterol (28.8
22.0 mg.dL-1 vs. -6.9 3.7 mg.dL-1, control)
compared to the control group from
baseline to eight-weeks (p < 0.05) but not in
the exercise group. Also, after eight weeks
of training, waist circumference decreased
significantly (p < 0.05 vs. control) in both
the E (0.8 0.2 cm) and ESS (1.7 0.0 cm)
groups compared to the control group.
Effect of sauna suit with exercise after an
eight week intervention on V̇O2max
After eight weeks of training, the ESS group
had an 11.7 % improvement in V̇O2max
compared to only a 7.3 % improvement in
the E group. A one-way ANOVA identified a
significant increase in V̇O2max in the ESS
group compared to the E and control
groups [F = 0.91, P <0.05] with the likely
range of 0.47 to 4.93%. Refer to Figure 2.
Post hoc testing identified that V̇O2max
values were significantly higher in the ESS
group (4.0 0.2 mL-1 . kg-1.min-1 ) versus the
E group (1.8 0.2 mL-1 . kg-1.min-1 ).
Effects of sauna suit with exercise after an
eight week intervention on body mass and
body fat
After eight weeks of training, the ESS group
had a 2.6 % reduction in body mass
compared to only a 0.9 % reduction in the E
group. A one-way ANOVA identified a
significant improvement in body mass in the
ESS group compared to the E and control
groups [F = 0.43, P <0.05] with the likely
range of -2.4 to -.30%. Refer to Figure 3.
Post hoc testing identified that body mass
values were significantly improved in the
ESS group (2.2 0.1 kg) versus the E group
(0.8 0.2 kg). Additionally, body fat
decreased by 13.8 % for the ESS group
compared to an 8.3% decrease with the E
group. A one-way ANOVA identified a
significant improvement in body fat in the
ESS group compared to the E and control
groups [F = 0.78, P <0.05] with the likely
range of -3.9 to -.13%. Refer to Figure 3.
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
Post hoc testing identified that body fat
values were significantly improved in the
ESS group (5.3 1.0 %) versus the E group
(3.3 0.2 %).
Effects of sauna suit with exercise after an
eight week intervention on fasting blood
glucose, RMR, and fat oxidation
After the eight week exercise training
intervention, the ESS group had a 7.7 %
reduction in fasting blood glucose
compared to the E group increasing their
blood glucose by 2.1 %. A one-way ANOVA
identified a significant improvement with
fasting blood glucose in the ESS group
compared to the E and control groups [F =
2.7, P <0.05] with the likely range of -15.9 to
-2.8%. Refer to Figure 4. Post hoc testing
identified that fasting blood glucose values
were significantly improved in the ESS
group (7.5 0.3 mg.dL-1) versus the E group
actually increasing their fasting blood
glucose after the intervention (2.5 21.9
mg.dL-1). RMR also improved significantly
for the ESS group compared to the E and
control groups [F = 0.14, P <0.05] with the
likely range of 0.24 to 0.93%. Specifically,
RMR improved by 11.4% for the ESS group
and decreased 2.7% for the E group. Post
hoc testing identified that RMR values were
significantly improved in the ESS group (0.4
0.26 L-1 . kg-1.min-1) versus the E group (0.1
0.2 L-1 . kg-1.min-1). Finally, the eight week
training intervention found that fat
oxidation improved by 3.8% for the ESS
group and decreased by 2.6%. A one-way
ANOVA identified a significant improvement
with fat oxidation in the ESS group
compared to the E and control groups [F =
0.02, P <0.05] with the likely range of -0.83
to -0.16%. Refer to Figure 4. Post hoc
testing identified that fat oxidation values
were significantly improved in the ESS
group (0.3 0.1) versus the E group
increasing their fat oxidation after the
intervention (0.2 0.01).
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Table 2. Physical and physiological characteristics at baseline and 8wks for control, exercise,
and sauna suit with exercise groups. (mean SD).
Control Group
Exercise Group
ESS Group
(n=13, women= 7, men= 6)
(n=12, women= 9, men= 3)
(n=16, women=11, men 5)
Parameter
Baseline
8 wk
Baseline
8 wk
Baseline
8 wk
Age (yr)
48.2 8.9
____
52.3 10.6
____
46.7 10.9
____
Height (cm)
169.8 10.9
____
170.6 11.1
____
169.4 9.4
____
Body Mass (kg)
87.2.7 9.3
87.5 9.0
87.5 9.0
90.1 22.1
83.1 13.9
80.9 13.8*
Waist Circumference (cm)
90.3 6.7
90.6 7.0
95.6 15.4
94.0 15.4
89.2 10.4
87.5 10.4*
Body Fat (%)
32.8 5.7
33.5 2.9*
39.9 4.6
36.6 4.4*
38.3 3.5
33.0 4.5*
Resting HR (bmin-1)
65.5 12.1
64.9 8.5
73.1 11.6
69.4 8.1
70.3 10.3
65.6 7.1
Maximal HR (bmin-1)
166 13.1
168.2 13.1
163.2 14.3
164.2 13.1
169.3 11.7
164.1 3.2
VO2max (mLkg-1min-1)
30.6 6.1
30.2 5.9
24.8 6.6
26.6 6.4*
34.3 9.0
38.3 9.2*
Systolic BP (mmHg)
118.6 9.3
120.6 8.6
123.3 7.2
120.0 7.2*
118.5 9.5
114.3 5.7*
Diastolic BP (mmHg)
78.0 7.1
80.6 4.7
77.5 4.6
74.5 3.5
75.0 7.3
71.8 6.6
Total Cholesterol (mgdL-1)
190.2 32.2
197.1 28.5
207.7 32.9
198.3 31.6
222.9 64.1
194.1 42.1
HDL Cholesterol (mgdL-1)
51.1 21.2
48.9 19.1
57.9 21.6
54.5 20.6
58.4 21.5
52.3 14.0
LDL Cholesterol (mgdL-1)
111.5 28.0
115.7 26.4
125.3 32.9
122.7 34.3
138.6 51.2
115.7 35.0
Triglycerides (mgdL-1)
112.3 41.3
119.1 41.8
121.9 39.1
96.2 30.3
163.1 114.6
130.9 79.7
Fasting Blood Glucose (mgdL-1)
89.1 5.7
89.5 6.8
96.2 8.4
94.8 7.7
96.9 13.4
89.4 13.1*
Rest Metabolic Rate (mLkg-1min-1)
3.9 .30
3.9 .36
3.7 .49
3.6 .29
3.5 .27
3.9 .53*
Fat Oxidation
0.77 .05
0.79 .04 *
0.78 .07
0.80 .06
0.79 .04
0.76 .05*
*Within-group change is significantly different from baseline, p < 0.05; † Change from baseline is significantly different
than control group, p < 0.05; ‡ Change from baseline is significantly different than control and E groups, p < 0.05.
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Western State Colorado University
Figure 2. Pre- and post V̇O2max for exercise with sauna suit (ESS) and exercise alone (E) group. *Within-
group change is significantly different from baseline, p < 0.05; † Change from baseline is significantly
different than control group, p < 0.05; ‡ Change from baseline is significantly different than control and
E groups, p < 0.05
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Western State Colorado University
Figure 3. Pre- and post weight (A) and body composition (B) for exercise with a sauna suit (ESS) and
exercise alone (E) group. *Within-group change is significantly different from baseline, p < 0.05; †
Change from baseline is significantly different than control group, p < 0.05; ‡ Change from baseline is
significantly different than control and E groups, p < 0.05.
[Year]
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Haney et al. (2017) Int J Res Ex Phys. 13(1):21-38.
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Exercise and Sport Science Program
Western State Colorado University
Figure 4. Pre-and post blood glucose (A), resting metabolic rate (B), and fat oxidation (C) for exercise
with a sauna suit (ESS) and exercise alone (E) group. *Within-group change is significantly different from
baseline, p < 0.05; ‡ Change from baseline is significantly different than E group, p < 0.05.
DISCUSSION
The major findings of this study were as
follows for the ESS group: 1) significant
improvement in V̇O2max when compared to
traditional exercise training alone in
overweight and obese individuals 2)
significant improvements in blood glucose,
RMR, fat oxidation, body mass, and body fat
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Western State Colorado University
in overweight and obese individuals
compared to exercise alone. These findings
support our hypotheses and justify using a
portable heat stress as an exercise training
strategy for overweight and obese
individuals who are trying to improve health
parameters. The results suggest that
exercise in a sauna suit can beneficially alter
health outcomes in overweight and obese
individuals. To our knowledge, this is the
first randomized, controlled trial
intervention to compare health related
benefits of training in a sauna suit versus a
traditional exercise program for overweight
and obese individuals.
In light of the current overweight and
obesity epidemic, the findings of this study
are extremely important. This research
provides evidence for a portable heat
training method that may assist with weight
loss and improve health outcomes in the
large percent of the world’s population who
are overweight and obese. Specifically,
these findings state that a portable heat
stress may elicit favorable health
improvements in a cohort of overweight
and obese individuals who are working out
three times a week at a moderate intensity
and two times a week at a vigorous
intensity based off HRR. It is noted that for
this population that short durations of
exercise, like those performed in the
present study, are safe when eliciting a heat
training adaptation. These findings are
important because the exercise prescription
in the present study aligns with public
health recommendations for overweight
and obese individuals16. Additionally, the
PACES questionnaire demonstrated that the
sauna suit was as comfortable as traditional
workout clothes for overweight and obese
individuals during exercise and did not
interfere with the exercise-training program
or adherence. Finally, this heat training
strategy is affordable and easy to use.
A novel finding from this research was the
significant increase in V̇O2max for the ESS
versus E group. It is well established that
endurance training intensity is a primary
determinant for exercise induced
improvements in V̇O2max16 but the
significant increase in the treatment group
may have been due to heat stress combined
with exercise training. Heat stress has been
shown to elicit plasma volume expansion,
improved myocardial efficiency, and
increased ventricular compliance, which can
allow larger end-diastolic volume and
greater cardiac outputs18. In addition,
research has found acclimatizing to the heat
to be beneficial for many physiological
adaptations, one of which is cardiovascular
endurance18. These adaptations may
explain the significant improvement in
V̇O2max in the ESS group due to a possible
increase in maximal cardiac output as a
result of plasma expansion. Epidemiological
data has also indicated that an elevation in
cardiorespiratory fitness is associated with
an attenuation of cardiometabolic risk
among individuals with MetS, a disease
associated with being overweight or obese9.
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Exercise and Sport Science Program
Western State Colorado University
The present research suggests that a sauna
suit may be an effective method for
improving V̇O2max and performance for
individuals who are overweight or obese. In
the present study the ESS group improved
their V̇O2max by 11.7 percent versus only a
7.3 percent improvement in the E group.
This improvement in cardiorespiratory
fitness is important for clinical findings
because it is well stated that a low
cardiorespiratory fitness might contribute
to physiological function and premature
death4. Additionally, research suggests a 15
percent reduction in mortality for a 10
percent improvement in cardiorespiratory
fitness4.
RMR, fasting blood glucose, and fat
oxidation were other health parameters
that improved in the ESS group. Physical
activity has been shown to significantly
affect RMR, which is responsible for the
largest component of total energy
expenditure throughout the day. Therefore,
it makes sense that there was both an
improvement in RMR and body composition
in the ESS group with the present study.
Studies have demonstrated a possible
increase in RMR after an exercise-training
program resulting in an elevated
metabolism, which coincides with the
findings of this study. Research
demonstrates acute physiological increases
in RMR post exercise5. These repeated
acute adaptations likely underpin the
chronic improvements we found in the
present study. Our findings show that acute
adaptations over an eight week training
intervention can result in chronic
improvements in RMR for overweight and
obese individuals. Additionally, EPOC is also
associated with rapid and prolonged rates
of elevated metabolism and may have been
elicited in the presented study due to
vigorous days of exercise bouts above 50-60
percent of V̇O2max. Various factors can
influence EPOC such as body temperature,
which was increased in the treatment group
for the present study5.
An elevated metabolism and exercise
training adaptations may also have played a
role in the significant improvement in
fasting blood glucose for the ESS group.
Research has shown an increase in skeletal
muscle glucose uptake during exercise due
to increased rates of glucose delivery,
surface membrane transport, and
intracellular substrates flow through
glycolysis17. The population for the present
study was overweight and obese
individuals. These individuals tend to have
poor fat oxidation, which results in
incomplete beta oxidation. As a result, this
causes an inflammatory response and
blocks glucose from entering the cell.
Additionally, the improvements in insulin-
mediated glucose uptake may have been
attributed to a training response resulting in
increased alternative mechanisms such as
an abundance and redistribution of glucose
transporter protein (GLUT 4) and other
intracellular signaling pathways. This aligns
with our findings stating that the
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Exercise and Sport Science Program
Western State Colorado University
improvement in fasting blood glucose in the
ESS group may have gone hand in hand with
the significant improvement in fat oxidation
and an exercise induced training response.
Research has shown that aerobic exercise is
more effective in increasing carbohydrate
oxidation during exercise, resulting in
glycemic control during and after exercise,
thus causing increased fat oxidation during
recovery2. This response may also be
associated with EPOC after vigorous
exercise training. Vigorous exercise, like
that performed Tuesdays and Thursdays in
the present study, results in greater
neuromuscular activity, muscle mass, and
metabolic demand during and after
exercise. This may have lead to greater
magnitudes of EPOC because of the larger
activity of the endocrine and metabolic
systems resulting in elevated cardiovascular
and respiratory responses. The research
mentioned aligns with the findings of the
present study, indicating that ESS may elicit
increased metabolism, glycemic control,
and fat oxidation during recovery by
increasing metabolic demand. These
findings are extremely important for
individuals who are overweight or obese
because they may be associated with blood
glucose uptake and glycemic control, thus
resulting in reduced body fat and improved
insulin sensitivity6,8.
Nonetheless, the present study is not
without limitations. The participants
consisted of a convenience sample and
therefore findings from the present study
may not be generalizable to the larger
population. Another limitation was that
dietary intake and activity/sedentary
behaviors outside the training program
were not monitored during the eight-week
intervention, which could have influenced
the current findings. Future research can
look into incorporating resistance training
into the exercise prescription and trying to
control for more behaviors outside of the
intervention such as activity/inactivity and
dietary intake.
CONCLUSIONS
The results of the present study suggest
that a portable heat stress, such as that
with a sauna suit, may promote increases in
cardiometabolic health and help lower
undesirable health parameters associated
with being overweight or obese. These
findings are important for individuals who
are trying to improve glycemic control,
reduce body weight, and increase fat
oxidation. These novel findings are
encouraging for individuals who are trying
to improve their health and fitness
professionals involved with the prevention
of chronic disease.
Competing interests
This investigation was supported financially by
the American Council on Exercise (ACE). The
American Council on Exercise (ACE) was not
involved in development of the study design,
data collection and analysis, or preparation of
the manuscript. There are no other potential
conflicts of interest related to this article.
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Exercise and Sport Science Program
Western State Colorado University
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... In physically active men, data show that completion of a single bout of moderate and vigorous exercise while wearing a sauna suit enhanced EE during and 1 hour post-exercise (6). In addition, completion of 6-8 weeks of moderate-to-vigorous exercise while wearing a sauna suit improved health status in healthy and overweight/obese adults (13,38). For example, Haney et al. (13) reported greater weight loss in obese adults who wore a sauna suit during completion of 8 weeks of MICE vs. individuals who did not wear a sauna suit. ...
... In addition, completion of 6-8 weeks of moderate-to-vigorous exercise while wearing a sauna suit improved health status in healthy and overweight/obese adults (13,38). For example, Haney et al. (13) reported greater weight loss in obese adults who wore a sauna suit during completion of 8 weeks of MICE vs. individuals who did not wear a sauna suit. ...
... Subsequently, subjects completed a single session of HIIE with or without a sauna suit (Kutting Weight, Sauna Suit V3, Van Nuys, CA). This sauna suit is similar to those used in previous studies (13,38). Before exercise, resting BLa was obtained in duplicate using a finger stick (Lancing Device; CVS Pharmacy Inc., Woonsocket, RI) and analyzed using a portable analyzer (Lactate Plus, Nova Biomedical, Waltham, MA). ...
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Matthews, ARD, Astorino, TA, Crocker, GH, and Sheard, AC. Acute effects of high-intensity interval exercise while wearing a sauna suit on energy expenditure and excess post-exercise oxygen consumption. J Strength Cond Res XX(X): 000-000, 2020-The use of sauna suits has increased because of claims that they enhance weight loss and increase body temperature during exercise. Therefore, the purpose of this study was to examine changes in energy expenditure (EE) and excess post-exercise oxygen consumption (EPOC) in response to high-intensity interval exercise (HIIE) while wearing a sauna suit. Twelve recreationally active men and women age = (28.7 ± 6.0 years) initially completed assessment of resting metabolic rate and maximal oxygen uptake. On two separate days, subjects completed HIIE consisting of ten 1-minute intervals at 85% peak power output, both with and without a sauna suit. Oxygen consumption, heart rate, and core temperature were continuously measured during and 1 hour after exercise. Energy expenditure during (285 ± 57 kcal vs. 271 ± 58 kcal) and post-exercise (123 ± 30 kcal vs. 113 ± 16 kcal) was significantly higher (p = 0.025) with a sauna suit than without a sauna suit. However, EPOC (6.19 ± 4.46 L of O2 vs. 4.25 ± 3.36 L of O2; p = 0.05) was not significantly different 1 hour after exercise, and core temperature was similar (p = 0.62) between conditions. Fat oxidation was significantly increased for 60 minutes after HIIE with a sauna suit (p = 0.009). Wearing a sauna suit during HIIE elicits greater EE vs. not wearing a sauna suit, but the increase of 23 kcal may not benefit weight loss.
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