Psychological response to exercise training and/or energy restriction in obese women

doi:10.1016/S0022-3999(99)00066-5

Journal of Psychosomatic Research

Volume 48, Issue 1, January 2000, Pages 23-29

https://doi.org/10.1016/S0022-3999(99)00066-5 Get rights and content

Abstract

Objective: The effect of 12 weeks of exercise training (five 45-minute walking sessions/week at 60% to 75% maximum heart rate) and/or moderate energy restriction (4.19 to 5.44 MJ or 1200 to 1300 kcal/day) on psychological general well-being (GWB) and profile of mood states (POMS) was studied in obese women (n = 91, age 45.6 ± 1.1 years, body mass index 33.1 ± 0.6 kg/m²). Methods: Subjects were randomized to one of four groups: control (C); exercise (E); diet (D); and exercise and diet (ED). Psychological variables were measured in all subjects at three timepoints—prestudy, 3 weeks, and poststudy—and analyzed using a 4 × 3 repeated measures design. Results: GWB but not POMS was improved in ED (but not E or D) relative to C poststudy, especially in four of six subscales: freedom from health concern or worry, life satisfaction; cheerful versus depressed mood; and relaxed versus tense feelings. Conclusion: These data demonstrate that the combination of moderate energy restriction and exercise training during a 12-week period improves psychological general well-being scores but not mood states in obese subjects.

Introduction

In 1985, the National Institutes of Health Consensus Development Panel on the Health Implications of Obesity concluded that “obesity creates an enormous psychological burden… In terms of suffering, this burden may be the greatest adverse effect of obesity” [1]. This statement, however, is based on a limited and often conflicting literature base 1, 2, 3, 4, 5, 6, 7, 8. Depression, for example, which has been studied more than any other mood measure, has been reported to be positively or negatively associated with obesity depending on the age and gender of the subject 3, 4, 5, 6. Although no clear consensus has emerged, some reviewers have concluded that the obese exhibit mental health function comparable to that of the general population 2, 4.

Little research has been conducted on the psychological effects of voluntary weight loss in obese subjects 4, 7, 9, 10, 11, 12, 13, 14. Although clinical findings suggest positive changes following weight loss, including improvements in mood, self-esteem, and body image, well-designed, randomized, controlled studies are lacking [7]. Antiobesity surgery has been associated with improved self-esteem and positive emotions [2], and subjects generally report reduced feelings of depression and anxiety following very low energy diet (VLED) programs 4, 7, 9, 10. Moderate energy restriction (e.g., 5000 to 6000 kJ/day) has been associated with decreased depression in one study [12].

The method of weight loss may have a differential effect on psychosocial function, but few data exist on this issue [7]. Physical fitness and activity have been consistently linked to improved mood and self-esteem, and may enhance the effects of diet alone 11, 12, 14, 15, 16, 17. Geliebter et al. [12] reported that the combination of diet and exercise reduced Beck Depression Inventory scores significantly more than diet alone in an 8-week study of 65 moderately obese men and women. Wadden et al. [13], however, showed that a decrease in depression and fatigue and an increase in vigor were experienced by all obese groups losing weight whether the method was through diet alone or in combination with exercise.

Additional research is needed to determine the influence of obesity and weight loss on psychological mood state, and whether the combination of diet and exercise is associated with more favorable changes than diet alone 2, 7. The purpose of this study was to compare psychological mood state in obese and nonobese women, and then to determine the influence of 12 weeks of moderate energy restriction and/or exercise on mood state using a randomized, controlled research design. Wadden et al. [7] reported that patients often experience improvements in mood state within the first few weeks of treatment. To test this hypothesis, psychological measures were taken at three timepoints: prestudy; 3 weeks; and poststudy.

Section snippets

Subjects and research design

Obese female subjects were recruited from the surrounding community through advertisements according to selection criteria used by us in previous studies 18, 19. The selection criteria were verified by both telephone and written surveys: (1) between the ages of 25 and 70 years; (2) in good health, with no known diseases including diabetes, cancer, or heart disease (verified by personal physician exam within previous 2 years); (3) a body mass index between 25 and 50 kg/m²; (4) not currently on a

Results

Of the 102 obese subjects recruited for the study, all but 11 complied with the research design, giving a final subject count of 91. The obese and nonobese groups were of similar age and height (Table 1). Obese compared with nonobese subjects had 53% greater body mass, nearly twice the body fat percentage, and a 44% lower VO_2max. Table 2 and Fig. 1 show that the obese compared with nonobese had lower GWBS total and subscale scores (except for relaxed vs. tense), and higher POMS global score,

Discussion

These data demonstrate that obese have less favorable psychological profiles than nonobese individuals. The combination of moderate energy restriction and exercise training during a 12-week period improved psychological general well-being scores, but not mood states, nearly to the level of the nonobese. Energy restriction or exercise training alone, however, was not associated with improvement in psychological profiles when compared with randomized controls.

Wadden et al. [7] reported that most

Acknowledgements

This work was funded by a Cybex grant from the American College of Sports Medicine. We acknowledge the assistance of the following individuals in this research project: Cathy Nieman, Colleen Utter, Libba Shannonhouse, Angie Ward, and Brindley Garner.

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This systematic review and meta-analysis has been registered with PROSPERO (CRD42021252307).
Impact of a short-term low calorie diet alone or with interval exercise on quality of life and oxidized phospholipids in obese females
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The objective of this study was to test if a low-calorie diet plus interval exercise (LCD+INT) reduced oxidized and non-oxidized phospholipids in relation to improved weight-related quality of life (QoL) to a greater extent than an energy-deficit matched LCD in obese females. Subjects (age: 47.2 ± 2.6 years, body mass index: 37.5 ± 1.3 kg/m²) were randomized to a 13-day LCD (n = 12; mixed meals of ∼1200 kcal/day) or LCD+INT (n = 13; 12 sessions of 60 min/day alternating 3 min at 50% and 90% peak heart rate plus an additional 350 kcal shake fed after exercise to match energy availability between groups). Weight-related QoL (Laval Questionnaire) as well as oxidized (POVPC, HOOA-PC, HPETE-PC, HETE-PC, PEIPC, KOOA-PC) and non-oxidized (PAPC and lysoPC) phospholipids were assessed pre- and post-intervention. Fitness (VO₂peak), body composition (BodPod), and clinical bloods were also tested. LCD+INT significantly increased VO₂peak (mL/kg/min, P = 0.03) compared to LCD despite similar fat loss, blood glucose, insulin sensitivity, and inflammatory responses. LCD+INT had significantly greater increases in QoL sexual life domain (P = 0.05) and tended to have a greater increase in the emotions domain (P = 0.09) and total score (P = 0.10) compared to LCD. There were no significant differences between treatments for changes in phospholipids despite LCD+INT increasing measured oxidized and non-oxidized phospholipids while LCD decreased POVPC, HOOA-PC, and PEIPC as well as non-oxidized PAPC and lysoPC. Interestingly, the rise in PEIPC correlated with elevated VO₂peak (mL/kg/min r = 0.42, P = 0.05). Decreased caloric intake was, however, linked to a decrease in PAPC (r = 0.53, P = 0.01), lysoPC (r = 0.52, P = 0.02), POVPC (r = 0.43, P = 0.05), and HPETE-PC (r = 0.43, P = 0.05). The decrease in HETE-PC also correlated with increases in the QoL domains symptoms (r = -0.46, P = 0.04), hygiene/clothing (r = -0.53, P = 0.01), emotions (r = -0.53, P = 0.01), social interactions (r = -0.49, P = 0.02), and total score (r = -0.52, P = 0.02). In conclusion, although LCD and LCD+INT improved weight related QoL over 13 days in females with obesity, LCD+INT tended to improve sexual life, emotions as well as total QoL score more than LCD. These data suggest caloric restriction and fitness may act through different mechanisms to support QoL.
Exercise for depression as a primary and comorbid with obesity disorder: A narrative
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Depression is a serious mental health disorder and would be the major public health problem worldwide by 2030. To this extent, conventional depression treatments are challenged and alternative or add-on antidepressant interventions are essential. In this narrative, we discuss the antidepressant role of exercise. Particularly, we discuss clinical evidence from meta-analytic reviews for the causal link of exercise with depression relief in adults (18–65 years) with major depression diagnosis as a primary disorder. Also, the mean- and individual-based pragmatic evidence for the antidepressant effect of exercise in depressed adults is described. Finally, we discuss the effects of exercise on depression as a comorbid with obesity disorder because obesity contributes to depression development regardless of the weight inducing metabolic side effects.
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Citation Excerpt :
All 5 reported significant improvements in several QoL domains (e.g., psychosocial functioning, physical functioning, self-esteem, public distress) (Baillot et al., 2012; del Rey-Moya et al., 2013; Lucha-LÓPez et al., 2012; Muller-Pinget et al., 2012; Wouters et al., 2010). Four RCTs reported results on depression (Abou-Raya et al., 2014; Napoli et al., 2014; Nieman et al., 2000; Sarsan et al., 2006), 2 of which used the Beck Depression Inventory (Abou-Raya et al., 2014; Sarsan et al., 2006), 1 used the Geriatric Depression Scale (Napoli et al., 2014), and 1 used the Profile of Mood Scale (Nieman et al., 2000). No CCT or before-and-after study reported results on depression.
Reviews show that exercise reduces many obesity-related physical health problems. However, it is unclear whether those benefits extend to psychosocial outcomes. The aim of this review was to evaluate the effect of exercise on psychosocial outcomes in adults with obesity.
Seven databases (Pubmed, Cochrane Library, EMBASE, CINAHL, Psyarticle, SportDiscus, Proquest) were searched until October 2017 to identify relevant studies published in peer-reviewed journals. Two reviewers independently screened articles against the following inclusion criteria: used an experimental or quasi-experimental design, involved adults with a body mass index ≥30 kg/m², delivered an intervention consisting of supervised or semi-supervised exercise, and assessed quality of life (QoL), depression, anxiety, and/or body image as outcomes.
Twenty two articles were included in this review; 16 were randomized controlled trials (RCT). Most interventions were supervised and lasted ≤16 weeks. Meta-analysis of RCTs with available data on QoL (k = 7) and depression (k = 4) did not show that exercise was significantly superior to control conditions for physical QoL (g = 0.16, 95%CI [-0.05,0.37]), mental QoL (g = 0.20, 95%CI [-0.09,0.48]), or depression (g = −0.26, 95%CI [-0.70,0.19]). Only three studies reported data on anxiety and body image.
Current evidence does not suggest exercise is successful in significantly enhancing psychosocial health in adults with obesity. Limitations associated with the reviewed studies could have biased the results toward a lack of effect. Additional high-quality RCTs are needed to improve evidence-based knowledge.
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Predominantly white (97%), morbidly obese (BMI ≥ 35 kg m⁻² with at least one co-morbid condition or a BMI ≥ 40 kg m⁻²) pre-menopausal women (N = 62), aged between 24 and 55 years were initially randomly assigned to 12 weeks of lifestyle intervention (IIG) or delayed start control group (DSCG). The program consisted of 3 months intensive lifestyle intervention followed by 9 month maintenance phase. The DSCG group commenced the program after 3 months.
Initially, the IIG showed a significant decrease in body weight (baseline to end of the RCT phase) compared with a significant increase in the DSCG group. However, no significant changes in weight status were evident in either group at 12 months compared with baseline. The 3-month intensive intervention resulted in significantly improved psychological functioning in both groups, which were maintained at 12 months. The study provides additional support for a non-dieting, theory-based, lifestyle approach to weight management and psychological well-being among morbidly obese females.
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Cet article propose une synthèse de la littérature des effets des pratiques d’activités physiques adaptées sur les principales variables psychologiques et psychosociales chez des patients malades chroniques avec le parti pris d’une lecture transversale de ces maladies (et non spécifique à une en particulier) et du respect de l’approche Evidence-Based Medicine/Psychology.
Malgré l’hétérogénéité des méthodologies et des programmes utilisés, quatre catégories de bénéfice en lien avec la santé peuvent être distingués, les retentissements subjectifs globaux, les ressources psychologiques et cognitives, les indicateurs comportementaux et les indices sociaux. Les résultats mettent en évidence des bénéfices psychosociaux liés à la santé de la pratique régulière, dosée et individualisée d’activités physiques chez les personnes malades chroniques. Cette pratique améliore la santé mentale, réduit les effets secondaires des traitements, favorise l’appropriation de la maladie chronique, améliore l’autogestion de la maladie, réduit les soins non programmés et retarde l’apparition de nouvelles maladies. Les effets aversifs sont mineurs.
Des travaux restent à mener sur les mécanismes physiopathologiques, sur les fonctions cognitives et sur la survie afin d’augmenter le niveau de preuve. Des recherches interventionnelles sur les doses et le contenu des pratiques devraient également être menées.
Les preuves s’accumulent sur les bénéfices psychosociaux liés à la santé de la pratique régulière, dosée et individualisée d’activités physiques chez les personnes malades chroniques tant en phase de traitement qu’après.
This article proposes a review of effect of exercise on psychosocial factors in patients with chronic disease within a transversal analysis and evidence-based medicine/psychology approach.
Instead heterogeneity of methodologies and programs, four categories of effects linked to health may be distinguished, global subjective perceptions, psychological resources, behavioral indicators and social indices. The results show several benefits with periodic, dosed and individualized practice. Studies note an improvement of mental health, a decrease of side effect of treatments, a contribution for acceptance, an improvement of self-management, and a decrease of unscheduled care. Adverse effects are rare.
Further studies need to be conducted to better determine biopsychological pathways, cognitive function impacts and survey to increase level of evidence. Interventional studies are needed.
Evidence increases about the benefits of periodic, dosed and individualized practice of exercise on psychosocial factors linked to health in patients with chronic disease during treatments and after.

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Original articlesPsychological response to exercise training and/or energy restriction in obese women

Abstract

Introduction

Section snippets

Subjects and research design

Results

Discussion

Acknowledgements

Am J Clin Nutr

Am J Clin Nutr

J Psychosom Res

Am J Clin Nutr

Am J Clin Nutr

Am J Cardiol

J Psychosom Res

Am Heart J

Health complications of obesity

Ann Intern Med

Depressive symptoms and weight change in a national cohort of adults

Int J Obes

Body weight and psychological distress in NHANES I

Int J Obes

Social and psychological consequences of obesity

Ann Intern Med

Original articles
Psychological response to exercise training and/or energy restriction in obese women