title: Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis.
abstract: BACKGROUND
  In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals.
  
  
  METHODS
  An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².
  
  
  RESULTS
  Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose.
  
  
  CONCLUSIONS
  Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.
authors.affiliation: Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Baillot
authors.affiliation: Unit of Nutrition and Diabetes, Department of Endocrinology-Nutrition and Diabetes, University Hospital of Montpellier, Montpellier, France.
authors.forename: Ahmed J
authors.initials: AJ
authors.lastname: Romain
authors.affiliation: Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Boisvert-Vigneault
authors.affiliation: Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Mélisa
authors.initials: M
authors.lastname: Audet
authors.affiliation: Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Jean Patrice
authors.initials: JP
authors.lastname: Baillargeon
authors.affiliation: Research Centre on Aging, Health and Social Services Centre, Institute of Geriatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Faculty of Physical Education and Sports, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Isabelle J
authors.initials: IJ
authors.lastname: Dionne
authors.affiliation: Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Valiquette
authors.affiliation: Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec, Canada.
authors.forename: Claire Nour Abou
authors.initials: CN
authors.lastname: Chakra
authors.affiliation: Unit of Nutrition and Diabetes, Department of Endocrinology-Nutrition and Diabetes, University Hospital of Montpellier, Montpellier, France; INSERM U1046, Physiology and experimental medicine of heart and muscles, University of Montpellier, Montpellier, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Avignon
authors.affiliation: Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Langlois
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors
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