Effects of one-year once-weekly high-intensity interval training on body adiposity and liver fat in adults with central obesity: Study protocol for a randomized controlled trial

Edwin C Chin, Chit K Leung, Danny J Yu, Angus P Yu, Joshua K Bernal, Christopher W Lai, Derwin K C Chan, Heidi H Ngai, Patrick S H Yung, Chi H Lee, Daniel Y Fong, Shelley E Keating, Jeff S Coombes, Parco M Siu, Edwin C Chin, Chit K Leung, Danny J Yu, Angus P Yu, Joshua K Bernal, Christopher W Lai, Derwin K C Chan, Heidi H Ngai, Patrick S H Yung, Chi H Lee, Daniel Y Fong, Shelley E Keating, Jeff S Coombes, Parco M Siu

Abstract

Objective: This study aims to examine the effects of one-year, once-weekly high-intensity interval training (HIIT) on body adiposity and liver fat in adults with central obesity.

Methods: One-hundred and twenty adults aged 18-60 years with central obesity (body mass index ≥25, waist circumference ≥90 cm for men and ≥80 cm for women). This is an assessor-blinded randomized controlled trial. Participants will be randomly assigned to the HIIT group or the usual care control group. Each HIIT session will consist of 4 × 4-min bouts at 85%-95% maximal heart rate, interspersed with 3-min bouts at 50%-70% maximal heart rate. The HIIT group will complete one session per week for 12 months, whereas the usual care control group will receive health education. The primary outcomes of this study are total body adiposity and intrahepatic triglyceride content. The secondary outcomes include abdominal visceral adipose tissue, subcutaneous adipose tissue, body mass index, waist circumference, hip circumference, cardiorespiratory fitness, lean body mass, bone mineral density, blood pressure, fasting blood glucose, insulin, triglycerides, glycated hemoglobin, cholesterol profile, liver function enzymes, medications, adherence to exercise, adverse events, quality of life, and mental health. Outcome measure will be conducted at baseline, 12 months (post-intervention), and 24 months (one-year follow-up).

Impact of the project: This study will explore the benefits of long-term once-weekly HIIT with a follow-up period to assess its effectiveness, adherence, and sustainability. We expect this intervention will enhance the practical suitability of HIIT in inactive adults with central obesity, and provide insights on low-frequency HIIT as a novel exercise option for the management of patients with central obesity and liver fat.

Trial registration: ClinicalTrials.gov (NCT03912272) registered on 11 April 2019.

Keywords: Abdominal obesity; HIIT; Hepatic steatosis; High-intensity exercise; MAFLD.

Conflict of interest statement

The authors declare no competing interests.

© 2022 The Society of Chinese Scholars on Exercise Physiology and Fitness. Published by Elsevier (Singapore) Pte Ltd.

Figures

Fig. 1
Fig. 1
Flow diagram for participant screening, randomization, and interventions.
Fig. 2
Fig. 2
Training protocol in the HIIT group.

References

    1. Afshin A., Forouzanfar M.H., Reitsma M.B., et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.
    1. Sun Y.-Q., Burgess S., Staley J.R., et al. Body mass index and all cause mortality in HUNT and UK Biobank studies: linear and non-linear mendelian randomisation analyses. BMJ. 2019;364:l1042.
    1. Khan S.S., Ning H., Wilkins J.T., et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiology. 2018;3:280–287.
    1. Luppino F.S., de Wit L.M., Bouvy P.F., et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatr. 2010;67:220–229.
    1. Amiri S., Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatr. 2019;33:72–89.
    1. Cai G.-H., Theorell-Haglöw J., Janson C., et al. Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity. Sleep Med. 2018;46:81–87.
    1. Pang Q., Zhang J.-Y., Song S.-D., et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index. World J Gastroenterol. 2015;21:1650–1662.
    1. Younossi Z.M., Koenig A.B., Abdelatif D., Fazel Y., Henry L., Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.
    1. Rinella M.E. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313:2263–2273.
    1. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–1402.
    1. Garber E.C., Blissmer R.B., Deschenes A.M., et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–1359.
    1. Reichert F.F., Barros A.J.D., Domingues M.R., Hallal P.C. The role of perceived personal barriers to engagement in leisure-time physical activity. Am J Publ Health. 2007;97:515–519.
    1. Weston K.S., Wisløff U., Coombes J.S. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48:1227–1234.
    1. Thompson W.R. Worldwide survey of fitness trends for 2022. ACSM's Health & Fit J. 2022;26:11–20.
    1. Taylor J.L., Holland D.J., Mielke G.I., et al. Effect of high-intensity interval training on visceral and liver fat in cardiac rehabilitation: a randomized controlled trial. Obesity. 2020;28:1245–1253.
    1. Taylor J.L., Holland D.J., Keating S.E., et al. Short-term and long-term feasibility, safety, and efficacy of high-intensity interval training in cardiac rehabilitation: the FITR heart study randomized clinical trial. JAMA Cardiology. 2020;5:1382–1389.
    1. Sabag A., Way K.L., Sultana R.N., et al. The effect of a novel low-volume Aerobic exercise intervention on liver fat in type 2 diabetes: a randomized controlled trial. Diabetes Care. 2020;43:2371–2378.
    1. O'Donovan G., Lee I.-M., Hamer M., Stamatakis E. Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Intern Med. 2017;177:335–342.
    1. Chin E.C., Yu A.P., Lai C.W., et al. Low-frequency HIIT improves body composition and aerobic capacity in overweight men. Med Sci Sports Exerc. 2020;52:56–66.
    1. Chan A.W., Tetzlaff J.M., Gotzsche P.C., et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346
    1. Farrell G.C., Chitturi S., Lau G.K., Sollano J.D. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol. 2007;22:775–777.
    1. Weston K.S., Wisløff U., Coombes J.S. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48:1227–1234.
    1. Htun K.T., Pan J., Pasanta D., et al. Advanced molecular imaging (MRI/MRS/(1)H NMR) for metabolic information in young adults with health risk obesity. Life. 2021:11.
    1. Wong V.W., Chu W.C., Wong G.L., et al. Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography. Gut. 2012;61:409–415.
    1. Browning J.D., Szczepaniak L.S., Dobbins R., et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–1395.
    1. Lee S.S., Park S.H., Kim H.J., et al. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol. 2010;52:579–585.
    1. Byrne C.D., Patel J., Scorletti E., Targher G. Tests for diagnosing and monitoring non-alcoholic fatty liver disease in adults. BMJ. 2018;362
    1. Macfarlane D.J., Chan N.T., Tse M.A., Joe G.M. Agreement between bioelectrical impedance and dual energy X-ray absorptiometry in assessing fat, lean and bone mass changes in adults after a lifestyle intervention. J Sports Sci. 2016;34:1176–1181.
    1. Who . 1995. Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee.
    1. NIH . 2000. The Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults.
    1. Fletcher G.F., Ades P.A., Kligfield P., et al. Exercise standards for testing and training. Circulation. 2013;128:873–934.
    1. Balady G.J., Arena R., Sietsema K., et al. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122:191–225.
    1. Nana A., Slater G.J., Stewart A.D., Burke L.M. Methodology review: using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. Int J Sport Nutr Exerc Metabol. 2015;25:198–215.
    1. Taylor J.L., Holland D.J., Keating S.E., Bonikowske A.R., Coombes J.S. Adherence to high-intensity interval training in cardiac rehabilitation: a review and recommendations. J Cardiopulm Rehabil Prev. 2021;41:61–77.
    1. Lam C.L., Tse E.Y., Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539–547.
    1. Leung C.M., Wing Y.K., Kwong P.K., Lo A., Shum K. Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton Rating Scale of Depression. Acta Psychiatr Scand. 1999;100:456–461.
    1. American Psychiatric Association . fifth ed. 2013. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC.
    1. Yu X., Tam W.W., Wong P.T., Lam T.H., Stewart S.M. The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatr. 2012;53:95–102.
    1. Spitzer R.L., Kroenke K., Williams J.B.W., Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–1097.
    1. He X.Y., Li C., Qian J., Cui H.S., Wu W.Y. Reliability and validity of a generalized anxiety scale in general hospital outpatients. Shanghai Archives of Psychiatry. 2010;22:200–203.
    1. Tsai P.S., Wang S.Y., Wang M.Y., et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14:1943–1952.
    1. Siu P.M., Yu A.P., Benzie I.F., Woo J. Effects of 1-year yoga on cardiovascular risk factors in middle-aged and older adults with metabolic syndrome: a randomized trial. Diabetol Metab Syndrome. 2015;7:40.
    1. Siu P.M., Yu A.P., Chin E.C., et al. Effect of Tai Chi or coventional exercise on central obesity in middle-aged and older adults. Ann Intern Med. 2021;174(8):1050–1057.
    1. ICH harmonised guideline - guideline for Good clinical practice E6 (R2) 2016.
    1. Ioannidis J.P., Evans S.J., Gotzsche P.C., et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141:781–788.
    1. Siu P.M., Chin E.C., Wong S.H., et al. Low-frequency high-intensity interval training (HIIT) improves cardiorespiratory fitness and body composition in overweight adults. Med Sci Sports Exerc. 2018 abstract submitted to the 65th American College of Sports Medicine (ACSM) Annual Meeting.
    1. Bausell R.B., Li Y.F. Cambridge University Press; 2002. Power Analysis for Experimental Research: A Practical Guide for the Biological, Medical and Social Sciences.
    1. Wewege M., van den Berg R., Ward R.E., Keech A. The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes Rev. 2017;18:635–646.
    1. Batacan R.B., Jr., Duncan M.J., Dalbo V.J., Tucker P.S., Fenning A.S. Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. Br J Sports Med. 2017;51:494–503.
    1. Keating S.E., Johnson N.A., Mielke G.I., Coombes J.S. A systematic review and meta-analysis of interval training versus moderate-intensity continuous training on body adiposity. Obes Rev. 2017;18:943–964.
    1. Cassidy S., Thoma C., Hallsworth K., et al. High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial. Diabetologia. 2016;59:56–66.
    1. Hallsworth K., Thoma C., Hollingsworth K.G., et al. Modified high-intensity interval training reduces liver fat and improves cardiac function in non-alcoholic fatty liver disease: a randomized controlled trial. Clin Sci (Lond) 2015;129:1097–1105.
    1. Ye C., Giangregorio L., Holbrook A., Pullenayegum E., Goldsmith C.H., Thabane L. Data withdrawal in randomized controlled trials: defining the problem and proposing solutions: a commentary. Contemp Clin Trials. 2011;32:318–322.
    1. Salazar A., Ojeda B., Duenas M., Fernandez F., Failde I. Simple generalized estimating equations (GEEs) and weighted generalized estimating equations (WGEEs) in longitudinal studies with dropouts: guidelines and implementation in R. Stat Med. 2016;35:3424–3448.
    1. Moher D., Hopewell S., Schulz K.F., et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.
    1. Osaka T., Hashimoto Y., Hamaguchi M., Kojima T., Obora A., Fukui M. Nonalcoholic fatty liver disease remission in men through regular exercise. J Clin Biochem Nutr. 2018;62:242–246.
    1. Chalasani N., Wilson L., Kleiner D.E., Cummings O.W., Brunt E.M., Unalp A. Relationship of steatosis grade and zonal location to histological features of steatohepatitis in adult patients with non-alcoholic fatty liver disease. J Hepatol. 2008;48:829–834.
    1. Lundgren J.R., Janus C., Jensen S.B.K., et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med. 2021;384:1719–1730.
    1. Fearnbach S.N., Flanagan E.W., Höchsmann C., et al. Factors protecting against a decline in physical activity during the COVID-19 pandemic. Med Sci Sports Exerc. 2021;53(7):1391–1399.
    1. Chair S.Y., Chien W.T., Liu T., et al. Psychological distress, fear and coping strategies among Hong Kong people during the COVID-19 pandemic. Curr Psychol. 2021:1–20.

Source: PubMed

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