title: Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial.
abstract: BACKGROUND
  Maintenance of weight loss is a core problem in the treatment of obesity. Physical activity may improve maintenance and metabolic risk factors associated with obesity.
  
  
  OBJECTIVE
  (1) A walking training program of moderate intensity, started after weight reduction by a very-low-energy diet, improves maintenance of weight loss and obesity-related metabolic disorders; and (2) the effect of the training program is related to the prescribed amount of physical activity, ie, a higher amount (energy expenditure) leads to more favorable results.
  
  
  METHODS
  The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2). Eighty-two participants were randomized to this study; 74 participated in the follow-up assessment. A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program randomized in 3 groups: a control group with no increase in habitual exercise and with counseling on diet and relapse prevention; a walk-1 group, with a walking program targeted to expend 4.2 MJ/wk and diet counseling; and a walk-2 group, with a walking program of 8. 4 MJ/wk and diet counseling. Random permuted blocks within strata were used, with weight loss (in 3 classes) as the stratifying factor. After the intervention, the subjects were followed up for 2 years.
  
  
  METHODS
  Primary outcomes were body weight, fat mass, and waist circumference at the 2-year follow-up. Secondary outcomes were the levels of serum lipoproteins and lipids, plasma glucose, insulin, and blood pressure.
  
  
  RESULTS
  The mean weight loss after weight reduction was 13.1 kg. The main outcome variables remained stable during the maintenance program, but increased during the follow-up period. Compared with the end of weight reduction, weight regain at the 2-year follow-up was 3.5 kg less (95% confidence interval, 0.2-6.8) and waist circumference regain 3.8 cm less (95% confidence interval, 0.3-7.3) in the walk-1 group vs controls. The secondary outcomes showed a partial relapse during the maintenance program, and a further regain during the follow-up period.
  
  
  CONCLUSIONS
  Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference.
authors.affiliation: University of Helsinki, Lahti Research and Training Centre, Saimaankatu 11, FIN-15140 Lahti, Finland. mikael.fogelholm@helsinki.fi
authors.forename: M
authors.initials: M
authors.lastname: Fogelholm
authors.forename: K
authors.initials: K
authors.lastname: Kukkonen-Harjula
authors.forename: A
authors.initials: A
authors.lastname: Nenonen
authors.forename: M
authors.initials: M
authors.lastname: Pasanen
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001824:Body Constitution; D015992:Body Mass Index; D004038:Diet, Reducing / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000178:diet therapy / Q000534:rehabilitation*; D017697:Premenopause / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids