Healthy premenopausal women with overweight who lose weight through diet with or without aerobic or resistance exercise show a significant reduction in the risks of major adverse cardiovascular events (MACE) and type 2 diabetes (T2D). However, such risks have rebounded with weight regain.
“The one exception is that lower risk scores for T2D were sustained in those randomized to diet plus resistance exercise despite the weight regain,” the investigators said.
More than 200 sedentary women with overweight aged 21‒49 years were randomly allocated to diet plus aerobic exercise, diet plus resistance exercise, or diet only and completed an 800 kcal/day diet until BMI <25 kg/m2.
The investigators calculated the predicted 10-year MACE and T2D risks using cardiometabolic disease staging equations. They also analysed longitudinal changes and adherence effects using fractional logit models fit with generalized estimating equations.
The mean BMI of participants decreased from 28.3 to 23.9 kg/m2. After 1 year, weight increased to 25.8 kg/m2 at 1 year. [Obesity 2026;34:1869-1879]
All intervention groups demonstrated a reduction in MACE risk from baseline to post-weight loss and rebounded from post-weight loss to 1 year (p<0.001 for all). Notably, the diet-only group showed greater MACE reduction than the diet plus resistance exercise group (p=0.022).
Likewise, the risk of T2D decreased in all groups (p<0.001 for all), but women in the diet plus aerobic exercise and diet-only groups had a rebound. Participants in the diet plus resistance exercise group sustained a significant net reduction at 1 year (p=0.003). Furthermore, follow-up exercise adherence appeared to prevent T2D risk rebound (p=0.024).
“These data support the importance of maintaining structured exercise and weight loss following diet and exercise interventions and indicate that resistance exercise may have particular benefits in weight loss interventions aiming to prevent progression to T2D,” the investigators said.
Diabetes prevention
The interventions exhibited a slightly different effect on T2D risk than on MACE. After weight loss, women in all groups showed larger absolute reductions in the 10-year T2D risk, suggesting that weight loss has a greater effect to lower T2D than MACE risk, according to the investigators.
“During follow-up, the largest amount of rebound occurred within the diet-only group, while increments in risk at 1 year in diet plus aerobic and diet plus resistance were less marked, and diet plus resistance was the only group to maintain a significant net improvement,” they added.
Earlier trials observed that achieving and maintaining weight loss improved risk factors for diabetes. However, partial or full weight regain contributed to the deterioration of glycaemic control and other cardiometabolic traits. [Diabetes Care 2016;39:1345-1355; Diabetes Obes Metab 2022;24:1553-1564; Am J Prev Med 2011;41:366-375]
“In this context, the significant sustained improvement at 1 year in the diet plus resistance group could reflect the role of this type of exercise in preserving or increasing skeletal muscle mass and strength, which may be valuable in supporting glucose disposal capacity and metabolic resilience during weight regain, even if the group-level differences in risk rebound were not significant after correction,” the investigators said. [Arch Intern Med 2012;17:130-1312; Med Sci Sports Exerc 2017;49:40-46]