Exercise Training Volume and the Fitness-fatness Index in Adults With Metabolic Syndrome: A Randomised Trial

Abstract Background Cardiorespiratory fitness and fatness (notably central obesity) are mediating factors of the metabolic syndrome (MetS), and consequent cardiovascular disease (CVD)/mortality risk. The fitness-fatness index (FFI) combines these factors and has been reported to be a better indicator of CVD and all-cause mortality risk, beyond the capacity of either fitness or fatness alone . Objective This study sought to investigate the effects of different exercise volumes on FFI in adults with MetS. Methods This was a sub-study of the ‘ Ex ercise in the prevention of Met abolic Syndrome’ (EX-MET) multicenter trial. Ninety-nine adults diagnosed with MetS according to the International Diabetes Federation criteria were randomized to one of the following 16-week exercise interventions: i) moderate-intensity continuous training (MICT) at 60-70% HRpeak for 30 min/session (n=34, 150 min/week); ii) 4 x 4 min bouts of high-intensity interval training at 85-95% HRpeak, interspersed with 3-min active recovery at 50-70% HRpeak (n=34, 38min/session, 114 mins/week); and iii) 1 x 4 min bout of HIIT at 85-95% HRpeak (n=31, 17 min/session, 51 min/week). Cardiorespiratory fitness (peak oxygen uptake, V̇O 2 peak) was determined via indirect calorimetry during maximal exercise testing and fatness was the ratio of waist circumference-to-height (WHtR). FFI was calculated as V̇O 2 peak in metabolic equivalents (METs) divided by WHtR. A clinically meaningful response to the exercise intervention was taken as a 1 FFI unit increase. Results Seventy-seven participants completed pre and post testing to determine FFI. There was a greater proportion of participants who had a clinically meaningful change in FFI following high-volume HIIT (60%, 15/25) and low-volume HIIT (65%, 17/26) compared to MICT (38%, 10/26), but with no significant between-group difference (p=0.12). A similar trend was found when a sub-analysis comparing the FFI between those with type 2 diabetes (MICT, 33%, 3/9; high-volume HIIT, 64%, 7/11; and low-volume HIIT, 58%, 7/12) and without type 2 diabetes (MICT, 41%, 7/17; high-volume HIIT, 57%, 8/14; low-volume HIIT, 71%, 10/14). Conclusion This study suggests that the response to changes in FFI in adults with MetS is affected by aerobic exercise intensity.