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Effects of Weighted Hula-Hooping Compared to Walking on Abdominal Fat, Trunk Muscularity, and Metabolic Parameters in Overweight Subjects: A Randomized Controlled Study

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Background: Weighted hula-hoops have gained popularity, but whether they indeed reshape the trunk or have beneficial metabolic effects in overweight subjects is unknown. Objectives: To determine effects of hula-hooping and walking matched for energy expenditure on android fat %, trunk muscle mass, and metabolic parameters in a randomized cross-over study. Design: We recruited 55 overweight nondiabetic subjects, who were randomized to hula-hooping (HULA) for 6 weeks using a 1.5-kg weighted hula-hoop followed by walking (WALK) for another 6 weeks or vice versa. The increments in energy expenditure were similar by HULA and WALK. Body composition (dual-energy X-ray absorptiometry) and metabolic parameters were measured at baseline and after HULA and WALK. The primary endpoint was the change in fat % in the android region. Results: A total of 53subjects (waist 92 ± 1 cm, body mass index 28 ± 1 kg/m2) completed the study. Body weight changed similarly (-0.6 ± 0.2 vs. -0.5 ± 0.2 kg, nonsignificant; HULA vs. WALK). During the intervention the subjects hula-hooped on average 12.8 ± 0.5 min/day and walked 9,986 ± 376 steps/day. The % fat in the android region decreased significantly by HULA but not by WALK (between-group change p < 0.001). Trunk muscle mass increased more by HULA than by WALK (p < 0.05). Waist circumference decreased more by HULA than by WALK (-3.1 ± 0.3 cm vs. -0.7 ± 0.4 cm, p < 0.001; HULA vs. WALK). WALK but not HULA significantly lowered systolic blood pressure and increased HDL cholesterol while HULA significantly decreased LDL cholesterol. Conclusions: Hula-hooping with a weighted hula-hoop can be used to decrease abdominal fat % and increase trunk muscle mass in overweight subjects. Its LDL lowering effect resembles that described for resistance training.
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Published by S. Karger AG, Basel
Research Article
Obes Facts 2019;12:385–396
Effects of Weighted Hula-Hooping Compared
to Walking on Abdominal Fat, Trunk
Muscularity, and Metabolic Parameters
in Overweight Subjects: A Randomized
Controlled Study
Mari Lahelma a, b Sanja Sädevirta a, b Susanna Lallukka-Brück a, b
Ksenia Sevastianova a, b Linda Mustelin a, b Helena Gylling b
Bonny Rockette-Wagner c Andrea M. Kriska a, b Hannele Yki-Järvinen a, b
a Minerva Foundation Institute for Medical Research, Helsinki, Finland; b Department of
Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; c Department
of Epidemiology, University of Pittsburgh, Pittsburgh, PA , USA
Keywords
Body composition · Waist circumference · Obesity · Exercise
Abstract
Background: Weighted hula-hoops have gained popularity, but whether they indeed reshape
the trunk or have beneficial metabolic effects in overweight subjects is unknown. Objectives:
To determine effects of hula-hooping and walking matched for energy expenditure on an-
droid fat %, trunk muscle mass, and metabolic parameters in a randomized cross-over study.
Design: We recruited 55 overweight nondiabetic subjects, who were randomized to hula-
hooping (HULA) for 6 weeks using a 1.5-kg weighted hula-hoop followed by walking (WALK)
for another 6 weeks or vice versa. The increments in energy expenditure were similar by HULA
and WALK. Body composition (dual-energy X-ray absorptiometry) and metabolic parameters
were measured at baseline and after HULA and WALK. The primary endpoint was the change
in fat % in the android region. Results: A total of 53 subjects (waist 92 ± 1 cm, body mass in-
dex 28 ± 1 kg/m2) completed the study. Body weight changed similarly (–0.6 ± 0.2 vs. –0.5 ±
0.2 kg, nonsignificant; HULA vs. WALK). During the intervention the subjects hula-hooped on
average 12.8 ± 0.5 min/day and walked 9,986 ± 376 steps/day. The % fat in the android region
decreased significantly by HULA but not by WALK (between-group change p < 0.001). Trunk
muscle mass increased more by HULA than by WALK (p < 0.05). Waist circumference de-
creased more by HULA than by WALK (–3.1 ± 0.3 cm vs. –0.7 ± 0.4 cm, p < 0.001; HULA vs.
Receive d: February 27, 2019
Accepted: April 24, 2019
Published online: June 19, 2019
Mari Lahelma, MD
Depar tment of Medicine, University of Helsinki
Biomedicum Helsinki 1, Room C425B, Haar tmaninkatu 8
FI–00290 Helsinki (Finland)
E-Mail mari.lahelma @ helsinki.fi
www.karger.com/ofa
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Interna-
tional License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribu-
tion for com mercial purpose s as well as any distrib ution of modif ied material requ ires written pe rmission.
DOI: 10.1159/000500572
Mari Lahelma and Sanja Sädevirta contributed equally to this work.
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DOI: 10.1159/000500572
WALK). WALK but not HULA significantly lowered systolic blood pressure and increased HDL
cholesterol while HULA significantly decreased LDL cholesterol. Conclusions: Hula-hooping
with a weighted hula-hoop can be used to decrease abdominal fat % and increase trunk mus-
cle mass in overweight subjects. Its LDL lowering effect resembles that described for resis-
tance training. © 2019 The Author(s)
Published by S. Karger AG, Basel
Introduction
The metabolic/insulin resistance syndrome (MetS) refers to a cluster of abnormalities
that are either causes or consequences of insulin resistance and coexist particularly in over-
weight sedentary subjects [1]. Physical activity reduces the risk of MetS in the face of minimal
or no changes in body weight and it favorably influences all components of the MetS [2]. The
WHO recommends physical activity for adults aged 18–64 years – at least 150 min of moderate-
intensity or 75 minutes of vigorous-intensity activity a week [3]. In addition, muscle-strength-
ening activities should be done involving major muscle groups 2 or more days a week. Walking
is perhaps the most common form of physical activity, and often a suitable form of activity for
overweight subjects and those with MetS. However, not everyone is motivated or able to walk
and other factors such as the weather may pose limitations to walking. There is thus a need
to search for and test alternative physical activities for such individuals.
Hula-hooping is an ancient type of dance, which has recently experienced a comeback in
the form of aerobic core training [4]. Hula-hooping has been practiced in fitness classes
worldwide and utilized in activity-promoting video games such as the Nintendo Wii. The
energy expenditure (EE) of hooping has been estimated to vary from 3 to 7 kcal/min
(moderate-intensity activity) depending on the hoop, hooping style, and individual metabolic
factors [5]. The bigger and heavier the loop, the slower it rotates and the easier it is to use.
Hula hooping activates muscles in the trunk such as lower abdominals, psoas major, and back
extensors as well as those in the lower limbs (hip abductors and, to a small extent, muscles of
the knee and ankle) [6]. Data on the effects of hula-hooping on body composition are limited
to one uncontrolled study, in which hula-hooping decreased waist circumference [7].
However, in this study, metabolic parameters or fat and muscle masses were not determined.
It is unknown whether hula-hooping changes metabolic parameters and, if so, whether such
changes resemble those associated with resistance or aerobic training.
In the present study we wished to compare the effects of hula-hooping (HULA) and
walking (WALK) in overweight subjects. Our hypothesis was that HULA decreases abdominal
fat % and increases trunk muscle mass more than WALK. The primary endpoint was the %
change in android fat as measured by dual-energy X-ray absorptiometry (DEXA). Secondarily,
we examined whether HULA and WALK have different effects on metabolic features such as
glucose, insulin, blood pressure, and lipids. To this end, we randomized 55 volunteers to
either HULA or WALK for two 6-week periods in a cross-over fashion. Key parameters from
the first period of intervention, where the subjects were randomized to either HULA or WALK,
were also analyzed as if the trial was performed using a parallel design.
Materials and Methods
Study Subjects
The study subjects were recruited through advertisements using intranet and bulletin
boards in the Hospital District of Helsinki and Uusimaa. The following inclusion criteria were
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applied: (i) age between 18 and 70 years, (ii) central adiposity as measured by waist circum-
ference (> 80 cm in females and > 94 cm in males) [8], (iii) ability to hula-hoop for a minimum
of 1 min and possibility to hula-hoop either at home or at work, (iv) ability to communicate
meaningfully with the investigator, and (v) legal competence to provide written informed
consent. Exclusion criteria included: (i) clinical or biochemical evidence of diseases other
than obesity as judged by history, physical examination, and standard laboratory tests (vide
infra), (ii) excessive use of alcohol, i.e., over 20 g/day, (iii) use of medications known to affect
glucose or lipid metabolism, and (iv) pregnancy or lactation.
Study Objectives
The primary objective was to evaluate the % change in fat in the android region (vide
infra) as measured by DEXA during 6 weeks of HULA compared to 6 weeks of WALK. Secondary
objectives included comparison of changes induced by HULA compared to WALK in waist
circumference, relative and absolute trunk muscle mass measured by DEXA, and metabolic
parameters including fasting plasma glucose, fasting serum insulin, fasting serum lipids, and
liver enzymes.
Study Design
An overview of the study design and visits is shown in Figure 1. The study had a cross-
over design in which half of the subjects (n = 27) first hula-hooped for 6 weeks and then
walked for 6 weeks, while the other half (n = 26) first walked for 6 weeks and then hula-
hooped for 6 weeks. Key parameters were also analyzed using a parallel design, i.e., by
Fig. 1. Flow chart of study design. A total of 55 subjects were recruited and randomized into two groups. Half
of the subjects started with 6 weeks of hula-hooping (HULA) followed by 6 weeks of walking (WALK), while
the other half started by walking for 6 weeks and then switched to hula-hooping for another 6 weeks. A total
of 53 subjects completed the study. The primary endpoint was the % change in android fat as measured by
dual-energy X-ray absorptiometry (DEXA) before and after the interventions measured at visits 3 (week 0),
6 (week 6), and 9 (week 12). * The metabolic study (visits 2, 5, and 8) included blood sampling for measure-
ment of features of the metabolic/insulin resistance syndrome (lipids, liver enzymes, glucose, HbA1c, and
insulin) in addition to recording of blood pressure, body weight, height, and waist and hip circumferences.
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comparing groups randomized to hula-hooping (HULA first) or walking (WALK first) for the
first 6 weeks. To match EEs of the groups, we measured the effects of weighted hula-hooping
and walking on heart rate (HR) in 10 volunteers (age 38 ± 2 years, body mass index 25 ± 1
kg/m2) and then estimated average EEs. Resting HR averaged 64 ± 1 bpm. HR for 10 min
averaged 95 ± 2 bpm during hula-hooping and 97 ± 3 bpm during walking. The EE of hula-
hooping and walking were then calculated using an equation predicting EE based on HR,
weight, age, and gender [9]. EE averaged 3.8 ± 0.2 kcal/min during hula-hooping and 4.0 ± 0.3
kcal/min during walking. We therefore recommended the WALK group to walk an extra 10
min/day and the HULA group to HULA 11 min/day to achieve similar EEs (approximately 41
kcal/day) by both activities.
Screening (Visit 1). Subjects interested and potentially eligible for the study were invited
for a screening visit after a 12-h fast. All the visits occurred at the clinical research unit of the
Helsinki University Hospital. The subjects attended visits individually. At the screening visit,
written informed consent was obtained and a history and physical examination, including
measurement of waist and hip circumferences, body weight, and height, and recording of an
electrocardiogram, were performed. Blood samples (complete blood counts, and concentra-
tions of creatinine, sodium, potassium, alanine aminotransferase [ALT], glucose, and thyroid-
stimulating hormone) were taken. A pregnancy test was performed in women of child-bearing
potential. The ability to hula-hoop for at least 1 min without dropping the hula-hoop was
tested for. Eligible subjects were randomized to start either with HULA or WALK. Of a total of
61 subjects who were screened, 55 were eligible for the study; 6 subjects were not eligible
because of abnormal laboratory test results at screening (n = 6), and 2 subjects dropped out
from the study (traumatic fracture unrelated to the study in one case, and lack of compliance
in the other). A total of 53 subjects completed the study.
Baseline Measurements (Visits 2 and 3). Subjects eligible for the study based on the
screening visit were invited to a baseline visit, during which recording of blood pressure,
body weight, height, and waist and hip circumferences was repeated. Baseline blood samples
were taken after an overnight fast for measurement of complete blood count and concentra-
tions of ALT, HDL and LDL cholesterol, triglycerides, glucose, glycosylated hemoglobin A1c
(HbA1c), and insulin (visit 2). Baseline body composition was measured by DEXA within a few
days from the baseline study visit (visit 3).
HULA. After visit 3, the subjects commenced 6 weeks of either hula-hooping or walking
(Fig. 1). The exercise protocol consisted of 6 min of hula-hooping per day for the first week
with an addition of 2 min per day every week for the HULA group. All subjects were offered
a 1-h teaching session within 1 week prior to commencement of the HULA intervention
(Fig. 2). During this session, the subjects were taught the technique of hula-hooping (A.S.).
Each subject was provided with a hula-hoop weighing 1.5 kg.
WALK. The study subjects were provided with a pedometer (Walking Style III; Omron
Healthcare Corporation Ltd., Kyoto, Japan) which was worn to monitor activity during both
the HULA and WALK periods. In addition, the subjects kept a diary to record the number of
minutes hula-hooped each day. The study subjects were instructed to continue their normal
diet and maintain their other exercise habits as prior to the study.
Measurements during First Exercise Intervention (Visit 4). The subjects attended a clinical
visit in the middle of the exercise intervention (end of week 3). At this visit, body weight, waist
and hip circumferences, and blood pressure were measured, and compliance to the exercise
protocol was reviewed based on the exercise diary that the study subjects were asked to keep.
Measurements after First Exercise Intervention (Visits 5 and 6). Upon completion of 6
weeks of HULA or WALK, the subjects were invited to visits 5 and 6, which were identical to
those of visits 2 and 3 described above.
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Cross-Over of Exercise Intervention. After visits 5 and 6, the study subjects crossed over to
hula-hooping for those walking initially and vice versa. A hula-hooping training session was
held for those commencing HULA after WALK.
Measurements during Second Exercise Intervention (Visit 7). A clinical visit in the middle
of the exercise intervention period was carried out as described for visit 4.
Measurements after Second Exercise Intervention (Visits 8 and 9). The final visits were
carried out upon completion of 6 weeks of the second exercise intervention. The protocols of
these visits were identical to those of visits 5 and 6.
Measurements of Body Composition
DEXA and Other Measures of Body Composition. Body composition variables were
measured and calculated automatically by DEXA and its integral commercial software (Lunar
Prodigy Advance; GE Healthcare, Madison, WI, USA). The android region includes an area
from the top of the iliac crest to 20% of the distance from the iliac crest to the bottom of the
subject’s head. The gynoid region extends from the top of the greater trochanter down a
distance twice the height of the android region. The trunk region includes the neck, chest,
Fig. 2. A study subject hula-hoop-
ing using a 1.5-kg weighted hula-
hoop (published with permission
of the subject).
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abdominal, and pelvic areas. Its upper border is the chin and its lower border the intersect
between the middle of the femoral necks without touching the brim of pelvis [10]. The % fat
values in a given region were calculated as % fat = fat mass/(fat mass + lean mass + bone
mass) × 100. The % lean mass values were calculated as % lean = lean mass/(fat mass + lean
mass + bone mass) × 100. Body weight, height, and waist and hip circumferences were
measured as previously described [8].
Analytical Procedures
Fasting glucose, HbA1c, insulin, LDL and HDL cholesterol, triglyceride concentrations, and
ALT were measured as previously described [11]. To estimate whether liver fat content
changed during the interventions, we calculated the % liver fat using an equation, which was
developed in our laboratory by quantifying liver fat by proton magnetic resonance spec-
troscopy (1H-MRS) in 470 subjects [8].
Since we observed a significant decrease in LDL cholesterol (see Results) during the
HULA but not the WALK period, we determined whether this change was associated with
markers of cholesterol absorption or synthesis. For this, concentrations of squalene and
noncholesterol sterols were measured from nonsaponifiable serum material with capillary
gas-liquid chromatography using a 50-m-long Ultra 1 capillary column (Agilent Technologies,
Wilmington, DE, USA) [12].
Statistical Methods
All data were tested for normality of distribution using the D’Agostino-Pearson normality
test. Normally distributed data are shown as means ± standard error of mean (SEM) and non-
normally distributed data are shown as median (followed by the 25 and 75 percentiles).
Baseline characteristics were compared using the unpaired t test for normally distributed
data and the Mann-Whitney test for non-normally distributed data. Intervention effects
between intervention groups (HULA vs. WALK group) were analyzed using the clustered
complex samples general linear model with change (before vs. after intervention values) as
the dependent variable, intervention group (HULA vs. WALK) as the fixed factor, and baseline
values and period (order of intervention) as covariates (see online suppl. Table 4; for all
online suppl. material, see www.karger.com/doi/10.1159/000500572). Key variables were
also analyzed using a parallel design by comparing groups randomized to hula-hooping or
walking during the first 6-week period (HULA first vs. WALK first). For this, changes (the
group × time interaction) were compared using repeated-measures 2-way ANOVA with inter-
vention group (HULA vs. WALK) as the grouping variable and time (before vs. after) as the
paired factor. The calculations were performed using GraphPad Prism version 7.0 for Mac
(GraphPad Software Inc., San Diego, CA, USA) and IBM SPSS Statistics 24 (IBM corporation,
Armonk, NY, USA).
Results
Baseline Characteristics
Physical and biochemical characteristics of all subjects before the HULA (n = 53) and
the WALK (n = 53) periods were comparable (Table 1). The subjects were mostly women
(n = 50). For analysis of the data using a parallel design, online supplementary Table 1
shows characteristics of the subjects randomized first to hula-hooping (HULA first, n = 27)
or walking (WALK first, n = 26) for the first 6 weeks. These groups were also comparable
with respect to physical and biochemical characteristics prior to receiving any inter-
vention.
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Table 1. Metabolic parameters and blood variables from fasting samples before and after HULA and WALK
Variables HULA (n = 53) WALK (n = 53) pa
before after difference pbefore after difference p
Waist, cm 90
(86 to 96)
87 (83 to 93) –3±0 <0.0001 90
(86 to 94)
90±1 –1±0 NS <0.001
Hip, cm 103
(98 to 108)
102
(96 to 105)
–2
(–3 to 0)
<0.0001 102
(98 to 106)
102
(97 to 105)
–1
(–2 to +1)
NS NS
Waist-to-hip ratio 0.89±0.01 0.87
(0.83 to 0.90)
–0.02±0.00 0.0001 0.88±0.01 0.88±0.01 0.00
(–0.02 to +0.02)
NS 0.01
Weight, kg 77.6±1.7 77.0±1.7 –0.63±0.2 <0.001 77.6±1.7 77.1±1.7 –0.51±0.2 <0.01 NS
BMI, kg/m² 27.3
(25.5 to 29.4)
26.9
(25.3 to 29.2)
–0.2
(–0.6 to +0.1)
0.0005 27.1
(25.3 to 29.5)
27.7
(–0.3 to –0.05)
–0.19±0.1 0.02 NS
Whole body fat (DEXA), % 40.9±0.8 40.1±0.8 –0.85±0.2 <0.0001 40.7±0.8 40.7±0.8 –0.02±0.2 NS 0.01
Android fat (DEXA), % 47.2±0.9 45.2±0.9 –2.0±0.3 <0.0001 46.7±0.9 48.1
(45.1 to 50.3)
+0.1±0.4 NS <0.001
Trunk muscle mass (DEXA), kg 20.7
(18.7 to 22.5)
21.3
(19.6 to 22.8)
+0.37
(–0.39 to +0.92)
NS 21.2
(19.7 to 22.7)
20.5
(18.8 to 22.3)
–0.37±0.13 <0.01 0.03
Triglycerides, mmol/L 1.0
(0.7 to 1.6)
0.9
(0.7 to 1.6)
–0.1
(–0.2 to +0.1)
NS 1.0
(0.7 to 1.5)
1.0
(0.7 to 1.4)
0.0
(–0.2 to +0.1)
NS NS
HDL cholesterol, mmol/L 1.7±0.1 1.6
(1.5 to 1.9)
–0.0±0.0 NS 1.6
(1.5 to 1.9)
1.8±0.0 +0.1±0.0 0.03 NS
LDL cholesterol, mmol/L 3.4±0.1 3.2±0.1 –0.1
(–0.4 to +0.2)
0.01 3.2±0.1 3.3±0.1 +0.1
(–0.2 to +0.4)
NS 0.007
Glucose, mmol/L 5.1
(4.8 to 5.4)
5.0±0.1 –0.1±0.1 NS 5.0±0.1 4.9
(4.8 to 5.4)
0.0
(–0.2 to +0.4)
NS NS
HbA1c, mmol/mol 34.1±0.4 34.3±0.4 +0.2±0.3 NS 34.2±0.4 34.3±0.4 0.0
(–1.0 to +1.0)
NS NS
Insulin, mU/L 6.7
(5.2 to 8.8)
6.4
(4.7 to 8.9)
–0.1±0.3 NS 6.1
(4.8 to 8.9)
6.1
(4.7 to 8.3)
–0.1
(–2.5 to +1.8)
NS NS
ALT, U/L 21
(16 to 29)
20
(16 to 26)
–1
(–5 to +2)
NS 20
(16 to 27)
21
(18 to 26)
0
(–3 to +3)
NS NS
Systolic blood pressure, mm Hg 127
(116 to 141)
126
(115 to 143)
–1±1 NS 133±2.4 124
(116 to 140)
–4±1 0.01 NS
ALT, alanine aminotransferase; BMI, body mass index; DEXA, dual-energy X-ray absorptiometry; HbA1c, glycosylated hemoglobin A1c; HDL, high-density lipoprotein; LDL,
low-density lipoprotein. a p value for intervention (HULA vs. WALK) obtained from clustered CSGLM (see online suppl. Table 4 for details).
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Compliance
During the WALK period, the subjects reported the steps taken during 94 ± 2% of all
days, and during the HULA period during 92 ± 2% of all days. The subjects hula-hooped on
average 12.8 ± 0.5 min/day. During the WALK period, the subjects walked on average 9,986
± 376 steps/day and during the HULA period 8,974 ± 359 steps/day (online suppl. Table
2).
Body Weight, Android Fat %, and Other Measures of Body Composition
Cross-Over Design. Changes in body weight were comparable between the exercise
modalities (–0.6 ± 0.2 vs. –0.5 ± 0.2 kg, NS; change during HULA vs. WALK; Fig. 3A). The
primary endpoint, the android fat %, decreased significantly (p < 0.001 with period and
before-intervention value as covariates) during HULA (–2.0 ± 0.3%, p < 0.0001) but not
during WALK (0.1 ± 0.4%; Fig. 3B). The absolute trunk muscle mass increased significantly
more (p < 0.03 with period and before-intervention value as covariates) during HULA than
during WALK (Fig. 3C). Waist circumference decreased significantly more (p < 0.001 with
period and before-intervention value as covariates) by HULA (–3.1 ± 0.3 cm) than WALK
(–0.7 ± 0.4 cm; Fig. 3D).
Pre- and postmenopausal women have differences in their fat distribution [13]. The
decreases in abdominal fat % (–2.2 ± 0.4 vs. –1.7 ± 0.5%, NS; pre- vs. postmenopausal) and
waist circumference (–3.0 ± 0.4 vs. –3.1 ± 0.5 cm, NS; pre- vs. postmenopausal) were similar
Fig. 3. Effect of exercise modalities on body weight (A), android fat % (B), trunk muscle mass (C), and waist
circumference (D). Data are given as mean ± SEM. * p < 0.05; ** p < 0.001; *** p < 0.0001; NS, nonsignificant.
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in pre- and postmenopausal women during HULA, but the study was not powered to examine
the effect of hula-hooping based on menopausal status.
Parallel Design. When analyzed using data from the HULA-first and WALK-first groups,
waist circumference decreased significantly more (p = 0.02 for changes in repeated-
measures 2-way ANOVA) in the HULA-first (–3.1 ± 0.4 cm) than the WALK-first (–1.0 [–2.6
to 0.5] cm) group. Changes in other body composition parameters were comparable (online
suppl. Table 1).
Metabolic Parameters
Cross-Over Design. LDL cholesterol decreased significantly more (p = 0.007 for inter-
vention with before-intervention LDL and period as covariates) during HULA (–0.1 [–0.40 to
+0.2] mmol/L) than WALK (+0.1 [–0.2 to 0.4] mmol/L, NS). The period effect was not signif-
icant, but LDL cholesterol decreased more in subjects with elevated before-intervention LDL
cholesterol (p = 0.007; online suppl. Table 4). HDL cholesterol remained unchanged during
HULA (0.0 ± 0.0 mmol/l) but increased (p < 0.05) significantly during WALK (+0.1 ± 0.0
mmol/L). The period effect was not significant, but HDL increased more in subjects with
initially low HDL cholesterol (p < 0.0001 for before-intervention HDL as covariate). There
were no statistically significant differences in changes in serum triglycerides between the
groups (Table 1). Systolic blood pressure remained unchanged during HULA (–1 ± 1 mm Hg,
NS; before vs. after HULA) but decreased significantly during WALK (–4 ± 1 mm Hg, p < 0.02;
before vs. after WALK). Diastolic blood pressure did not change in either group. There were
no significant differences in changes between the groups in glucose, HbA1c, insulin, or ALT
concentrations (Table 1). For p values for covariates see online supplementary Table 4. Since
there was a significant difference between the groups in the change in LDL cholesterol concen-
trations, circulating markers of cholesterol synthesis and absorption were measured with
GC-MS. Markers of synthesis or absorption did not change significantly during HULA or WALK
(online suppl. Table 3).
Parallel Design. LDL decreased significantly more (p = 0.002) in the HULA-first than the
WALK-first group. There were no significant differences in other metabolic parameters
(online suppl. Table 1).
Discussion/Conclusion
There are no controlled studies addressing the effects of hula-hooping with weighted
hula-hoops on body composition or metabolic parameters. We found in a group of overweight
subjects that 6 weeks of hula-hooping for an average duration of 13 min per day significantly
decreased waist circumference and body fat in the android region and increased trunk muscu-
larity compared to a period of walking. These results were not due to changes in body weight
as hula-hooping and walking induced trivial and similar weight loss. Walking but not hula-
hooping increased HDL cholesterol and decreased systolic blood pressure while hula-hooping
lowered LDL cholesterol.
Hula-hooping decreased waist circumference by an amount that has been associated
with changes in other components of the MetS in studies using weight loss and aerobic
training as the therapeutic intervention [14]. In the meta-analysis of Yamaoka and Tango
[14], a decrease in waist circumference (–2.7 cm), i.e., an amount similar to that attained in
our study (–3 cm), was associated with significant improvements in metabolic parameters
including decreases in systolic (–6.4 mm Hg) and diastolic (–3.3 mm Hg) blood pressure,
serum triglycerides (–0.14 mmol/L), and fasting blood glucose (–0.63 mmol/L). However,
correlation does not prove causality [15, 16], and it is indeed controversial whether the asso-
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DOI: 10.1159/000500572
ciation between abdominal obesity and insulin resistance is “causative or correlative” [15] or
“a major culprit or simply an innocent bystander” [16]. The present data show that hula-
hooping locally reshapes the waist without changing other components of the MetS. This
effect is reminiscent of the effect of abdominal liposuction on whole-body insulin sensitivity,
blood pressure, or lipids [17]. In the latter study, removal of 44% of subcutaneous adipose
tissue in 15 women had no effect on whole body insulin sensitivity [17].
Regarding changes in markers of cardiovascular risk, WALK increased HDL cholesterol
and decreased systolic blood pressure. These changes are in keeping with known beneficial
effects of aerobic training on blood pressure and lipids [18, 19]. Our patients were already
active as they attained the global health recommendations of walking time at baseline. By
design, the extra walking time was low (10 min/day) and may underestimate the true benefits
of walking. Nevertheless, systemic changes with potential long-term cardiovascular benefits
were observed. This reinforces the idea that even moderately active people can attain health
benefits with a little increase in activity such as walking [20]. Given that WALK and HULA
induced similar increases in EEs, as determined by changes in HR, one might not expect these
activities to differentially affect cardiovascular risk factors. However, data comparing two
different types of exercise in the face of equal increases in HR are sparse. There are, indeed,
several examples where maximal aerobic capacity (VO2 max) and cardiovascular risk factors
have not changed in parallel during physical training. For example, in 8 out of 11 studies
examining the effects of aerobic exercise such as walking or bicycling on markers of cardio-
vascular risk, beneficial changes in serum triglycerides or HDL cholesterol were observed in
the absence of an improvement in VO2 max or change in body weight [21].
HULA but not WALK significantly decreased LDL cholesterol but did not change HDL
cholesterol or triglycerides. The decrease in LDL cholesterol and increase in trunk muscle
mass resemble effects observed during resistance training [22–25]. According to meta-
analyses by Kelley et al. [22–24] (2004, 2006, 2009), resistance training and aerobic training
have slightly different effects on lipid profile, as resistance training decreases LDL cholesterol
and non-HDL cholesterol without significant effects on HDL cholesterol, while aerobic training
primarily increases HDL cholesterol and, to a lesser degree, decreases LDL. The difference in
LDL cholesterol concentrations between the groups in the present study could be due to
changes in cholesterol absorption or synthesis, or perhaps due to changes in adipose tissue,
which is one of the largest body cholesterol pools in humans [26]. A dietary explanation is
unlikely since the order of the two exercise periods was randomized. As we perceived the
distinct effects on lipid profile as fascinating, we further investigated the markers of choles-
terol synthesis (desmosterol, lathosterol, cholestenol, and squalene) and absorption (choles-
tanol, campesterol, sitosterol, and avenasterol) (online suppl. Table 3). There were no signif-
icant changes between groups. The mechanism underlying the decrease in LDL cholesterol
thus remains unclear. Possibly, changes in adipose tissue cholesterol stores as a result of body
reshaping might influence circulating LDL cholesterol but this remains speculative. On the
other hand, it is still equally unclear why resistance training decreases LDL cholesterol. The
greater decrease in abdominal fat % by hula-hooping compared to walking could also differ-
entially affect concentrations of adipokines, which may regulate low-grade inflammation and
cardiovascular risk [27, 28].
Cross-over trials offer advantages in terms of power since each subject is studied
repeatedly. On the other hand, disentangling treatment effects from time and carryover
effects can be challenging [29]. These were not issues in the present study since comparison
of the main treatment effects for waist circumference and LDL cholesterol using parallel
design yielded similar results to those in the analysis of differences from the cross-over data.
Physical activity of the subjects was high, as it exceeded the global recommendation of daily
physical activity by WHO [3]. Whether hula-hooping would have even more beneficial effects
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DOI: 10.1159/000500572
in less active individuals with more severe features of MetS remains to be established. Men
were less eager to volunteer for the present study and therefore we cannot really make
conclusions regarding the effects of hula-hooping in men. Also, the results may not be appli-
cable to severely obese subjects.
We conclude that hula-hooping can reshape the body by increasing abdominal muscle
mass and decreasing waist circumference, which can be helpful extrinsic motivators to
exercise for overweight individuals. Interestingly, hula-hooping decreased LDL cholesterol, a
change typically induced by resistance rather than aerobic training. In contrast, even a small
increase in walking in already active overweight people had positive effects on lipids and
blood pressure. Taken together these data suggest that hula-hooping may complement the
beneficial effects of aerobic activities, such as walking, and could therefore be included among
activities recommended for overweight individuals.
Statement of Ethics
The study protocol was approved by the Medical Ethics Committee of the Hospital District
of Helsinki and Uusimaa. The study is registered at www.clinicaltrials.gov (No. NCT01913171).
The subjects gave their written informed consent.
Disclosure Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was supported by research grants from EVO and Sigrid Juselius Foundations.
Author Contributions
H.Y.-J.: study concept and design. S.S., L.M., and K.D.: acquisition of clinical data. M.L., S.S.,
A.M.K., B.R.-W., and S.L.-B.: analysis and interpretation of data and writing of the manuscript.
H.G.: acquisition of sterol data. A.S.: HULA training session. All authors performed critical
revision of the manuscript for important intellectual content.
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... Therefore, hula hooping is widely believed to be an excellent form of aerobic core training. Several previous studies (13,16,18,26,28) have demonstrated the positive effects of hula hoop exercise on weight loss, waist and hip circumference, lipid profile, body composition, muscle strength and flexibility, core muscle mass, and core strength. Interestingly, one previous quasi-experimental study showed that hula hooping was able to enhance TrA function, strengthen superficial back and abdominal muscles, and improve lumbar stability level (13). ...
... The positive effects of hula hooping exercise on core muscle activation in this study are congruent with previous reports (13,16,26) in that weighted hula hoop training was able to improve the strength of the abdominal and back extensor, increased the trunk muscle mass, promote core stability and the ability to contract the TrA. Conversely, McGill et al. (18) reported that torso muscle endurance was not improved subsequent to 6 wks of hula hooping using a weighted hoop. ...
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