Parámetros cardiometabólicos en el entrenamiento interválico de alta intensidad en personas con sobrepeso u obesidad: revisión bibliográfica

Julio Gallego-Méndez; David Ramos Escudero; José Carmelo Adsuar Sala; Jorge Pérez-Gómez

doi:10.19230/jonnpr.2919

Authors

Julio Gallego-Méndez Departamento de didáctica de la expresión musical, plástica y corporal. Facultad de Ciencias del Deporte. Universidad de Extremadura
David Ramos Escudero Departamento de didáctica de la expresión musical, plástica y corporal. Facultad de Ciencias del Deporte. Universidad de Extremadura
José Carmelo Adsuar Sala Departamento de didáctica de la expresión musical, plástica y corporal. Facultad de Ciencias del Deporte. Universidad de Extremadura
Jorge Pérez-Gómez Departamento de didáctica de la expresión musical, plástica y corporal. Facultad de Ciencias del Deporte. Universidad de Extremadura

DOI:

https://doi.org/10.19230/jonnpr.2919

Keywords:

High-intensity interval training, cardiometabolic health, body composition, lipid values, blood pressure, cardio respiratory fitness, obesity, overweight, HIIT

Abstract

Objective. The purpose of the present review was to know the situation in regard to how different cardiometabolic parameters and/or cardiometabolic health markers are influenced in overweight or obese people when a high-intensity interval training programme is applied.

Methods. A bibliographic search was carried out in the PubMed database. A total of 93 articles were analyzed and after inclusion a exclusion criteria application it were reduced to 12 the useful articles.

Results. There is a maintenance or significant decrease in body mass index (2.1±0.3%), body mass (3.3%, ?2%), fat mass (?2%), and waist circumference. The effects on lipid values are varied between articles, certains significant decreases have occurred in some articles when we look cholesterol (32.4±5.2mg/dl), low-density lipoprotein (25.8±16.5mg/dl) and tryglicerides (22.9±3.4mg/dl), however other studies show that there are not changes in these parameters or even a slight increase after the intervention is observed. Some articles show a reduction on glucose (1.1±0.11mmol/l), diastolic and systolic blood pressure. Oxygen consumption peak suffers a significative increasing in the majority of studies analyzed(27.7±4.4%, 22.3±3.5%, 9.1%, 7.9%, 7.9%).

Conclusions. High-intensity interval training allows improvements in: waist circunference, insulin sensitivity, blood pressure, lipid profile and peak of oxygen consumption. It also could control body weight and reduce fat mass. However, it is not clear that it could be effective for the modification of lipid values due to the controversy in the results.

Downloads

Download data is not yet available.

References

WHO. (2015). Obesity and overweight: fact sheet No 311 (updated January 2015). Janeiro 2015. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

Matsuzawa, Y., Funahashi, T., & Nakamura, T.. The Concept of Metabolic Syndrome: Contribution of Visceral Fat Accumulation and Its Molecular Mechanism. J Atheroscler Thromb. 2011; 18(8), 629–639. https://doi.org/10.5551/jat.7922

Schjerve, I. E., Tyldum, G. a, Tjønna, A. E., Stølen, T., Loennechen, J. P., Hansen, H. E. M., Haram,P.M., Heinrich, G., Bye, A., Najjar,S.M., Smith,G. L., Slørdahl,S.A., Kemi, O.J.,Wisløff, U.. Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults. Clin Sci (Lond). 2008; 115(9), 283–293. https://doi.org/10.1042/CS20070332

National Heart Lung and Blood Institute, & National Institutes of Health (NIH) National Heart, Lung, and Blood Institute, N. . Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report, NIH Publication No. 98- 4083.WMJ official publication of the State Medical Society of Wisconsin. 1998; (Vol. 158). Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK2003/

Anderssen, S. A., Carroll, S., Urdal, P., & Holme, I. . Combined diet and exercise intervention reverses the metabolic syndrome in middle- aged males: Results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports. 2007; 17(6), 687–695.

Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., Macera, C.A., Heath, G.W., Thompson, P.D., Bauman, A. . Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8), 1423-1434. https://doi.org/10.1249/mss.0b013e3180616b27

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(6), 635–646. https://doi.org/10.1111/obr.12532

Verheggen, R. J. H. M., Maessen, M. F. H., Green, D. J., Hermus, A. R. M. M., Hopman, M. T. E., & Thijssen, D. H. T. . A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev.2016; 17(8), 664–690. https://doi.org/10.1111/obr.12406

American College of Sports Medicine. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults - Position Stand. Med Sci Sports Exerc. 2009; 41(2), 459–471.

https://doi.org/10.1249/MSS.0b013e3181949333

Keating, S. E., Machan, E. A., O’Connor, H. T., Gerofi, J. A., Sainsbury, A., Caterson, I. D., & Johnson, N. A. . Continuous exercise but not high intensity interval training improves fat distribution in overweight adults. J Obes. 2014; vol. 2014,Article ID 834865, 1- 12.https://doi.org/10.1155/2014/834865

Kessler, H. S., Sisson, S. B., & Short, K. R. . The potential for high- intensity interval training to reduce cardiometabolic disease risk. Sports Med. 2012; 42(6), 489–509. https://doi.org/10.2165/11630910- 000000000-00000

Madsen, S. M., Thorup, A. C., Overgaard, K., & Jeppesen, P. B. . High intensity interval training improves glycaemic control and pancreatic β cell function of type 2 diabetes patients. PLoS One. 2015; 10(8). https://doi.org/10.1371/journal.pone.0133286

Ramos, J. S., Dalleck, L. C., Tjonna, A. E., Beetham, K. S., & Coombes, J. S. . The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. Sports Med. 2015; 45(5), 679– 692. https://doi.org/10.1007/s40279-015-0321-z

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(16), 1227-1234. https://doi.org/10.1136/bjsports-2013-092576

Gormley, S. E., Swain, D. P., High, R., Spina, R. J., Dowling, E. A., Kotipalli, U. S., & Gandrakota, R. . Effect of intensity of aerobic training on VO2max. Med Sci Sports Exerc. 2008; 40(7), 1336–1343. https://doi.org/10.1249/MSS.0b013e31816c4839

Bacon, A. P., Carter, R. E., Ogle, E. A., & Joyner, M. J. . VO2max Trainability and High Intensity Interval Training in Humans: A Meta- Analysis. PLoS One. 2013; 8(9). https://doi.org/10.1371/journal.pone.0073182

Elliott, A. D., Rajopadhyaya, K., Bentley, D. J., Beltrame, J. F., & Aromataris, E. C. . Interval Training Versus Continuous Exercise in Patients with Coronary Artery Disease: A Meta-Analysis. Heart Lung Circ. 2015; 24(2), 149–157. https://doi.org/10.1016/j.hlc.2014.09.001

Liou, K., Ho, S., Fildes, J., & Ooi, S.-Y. . High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters.Heart Lung Circ. 2016; 25(2), 166–174. https://doi.org/10.1016/j.hlc.2015.06.828

Milanović, Z., Sporiš, G., & Weston, M. . Effectiveness of High- Intensity Interval Training (HIT) and Continuous Endurance Training for VO Improvements: A Systematic Review and Meta-Analysis of Controlled Trials. Sports Med. 2015; 45(10), 1469–1481. https://doi.org/10.1007/s40279-015-0365-0

Batacan, R. B., 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 metaanalysis of intervention studies.Br J Sports Med. 2017; 51(6), 494-503. https://doi.org/10.1136/bjsports- 2015-095841

Heydari, M., Freund, J., & Boutcher, S. H.. The effect of high- intensity intermittent exercise on body composition of overweight young males. J Obes. 2012; vol. 2012, Article ID 480467, 1-8. https://doi.org/10.1155/2012/480467

Trapp, E., Heydari, M., Freund, J., & Boutcher, S. H. . The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women . Int J Obes. 2008; 32(4), 684–691. https://doi.org/10.1038/sj.ijo.0803781

Boutcher, S. H. . High-intensity intermittent exercise and fat loss.J Obes. 2011; vol. 2011, Article ID 868305, 1-10. https://doi.org/10.1155/2011/868305

MacPherson, R. E. K., Hazell, T. J., Olver, T. D., Paterson, D. H., & Lemon, P. W. R. . Run sprint interval training improves aerobic performance but not maximal cardiac output.Med Sci Sports Exerc. 2011; 43(1), 115–122. https://doi.org/10.1249/MSS.0b013e3181e5eacd

Hazell, T. J., Hamilton, C. D., Olver, T. D., & Lemon, P. W. R. . Running sprint interval training induces fat loss in women. Appl Physiol Nutr Metab. 2014; 39(March), 944–950. https://doi.org/10.1139/apnm- 2013-0503

Bahr, R., & Sejersted, O. M. . Effect of intensity of exercise on excess postexercise O2 consumption. Metabolism. 1991; 40(8), 836–841. https://doi.org/10.1016/0026-0495(91)90012-L

Gillette, C. a, Bullough, R. C., & Melby, C. L. . Postexercise energy expenditure in response to acute aerobic or resistive exercise. Int J Sport Nutr. 1994; 4, 347–360. https://doi.org/10.1123/ijsn.4.4.347

Gillen, J. B., Percival, M. E., Ludzki, A., Tarnopolsky, M. A., & Gibala, M. J. . Interval training in the fed or fasted state improves body composition and muscle oxidative capacity in overweight women. Obesity. 2013;21(11), 2249–2255. https://doi.org/10.1002/oby.20379

Metcalfe, R. S., Babraj, J. A., Fawkner, S. G., & Vollaard, N. B. J. . Towards the minimal amount of exercise for improving metabolic health: Beneficial effects of reducedexertion high-intensity interval training. Eur J Appl Physiol. 2012; 112(7), 2767–2775. https://doi.org/10.1007/s00421-011-2254-z

Perry, C. G. R., Heigenhauser, G. J. F., Bonen, A., & Spriet, L. L. . High-intensity aerobic interval training increases fat and carbohydrate metabolic capacities in human skeletal muscle. Appl Physiol Nutr Metab. 2008; 33(6), 1112–1123. https://doi.org/10.1139/H08-097

Vicente Campos, D. Actividad física, fitness cardiorrespiratorio y factores de riesgo metabólico en niños y adolescentes. Universidad Europea de Madrid. 2010.

Blair, S. N., Kohl, H. W., Paffenbarger, R. S., Clark, D. G., Cooper, K. H., & Gibbons, L. W. . Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989; 262(17), 2395–2401. https://doi.org/10.1001/jama.1989.03430170057028.

Helgerud, J., Høydal, K., Wang, E., Karlsen, T., Berg, P., Bjerkaas, M., Simonsen, Helgesen, C., Hjorth, N., Bach, R., Hoff, J. . Aerobic high- intensity intervals improve V̇O2max more than moderate training. Med Sci Sports Exerc. 2007; 39(4), 665–671. https://doi.org/10.1249/mss.0b013e3180304570

Rognmo, Ø., Hetland, E., Helgerud, J., Hoff, J., & Slørdahl, S. A. . High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2004; 11(3), 216–222. https://doi.org/10.1097/01.hjr.0000131677.96762.0c

Wisløff, U., Støylen, A., Loennechen, J. P., Bruvold, M., Rognmo, Ø., Haram, P. M., Tjønna, A.E., Helgerud, J., Slørdahl, S.A., Lee, S.J., Videm, V., Bye, A., Smith,G.L., Najjar,S.M., Ellingsen, Ø., Skjærpe, T. . Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: A randomized study. Circulation. 2007; 115(24), 3086–3094. https://doi.org/10.1161/CIRCULATIONAHA.106.675041

Alvarez, C., Ramirez-Campillo, R., Martinez-Salazar, C., Mancilla, R., Flores-Opazo, M., Cano-Montoya, J., & Ciolac, E. G. . Low-Volume High- Intensity Interval Training as a Therapy for Type 2 Diabetes. Int J Sports Med. 2016; 37(9), 723–729. https://doi.org/10.1055/s-0042-104935

Boyd, J. C., Simpson, C. A., Jung, M. E., & Gurd, B. J. . Reducing the Intensity and Volume of Interval Training Diminishes Cardiovascular Adaptation but Not Mitochondrial Biogenesis in Overweight/Obese Men. PLoS One. 2013; 8(7). https://doi.org/10.1371/journal.pone.0068091

Kong, Z., Fan, X., Sun, S., Song, L., Shi, Q., & Nie, J. . Comparison of high-intensity interval training and moderate-to-vigorous continuous training for cardiometabolic health and exercise enjoyment in obese young women: A randomized controlled trial. PLoS One. 2016; 11(7). https://doi.org/10.1371/journal.pone.0158589

Kong, Z., Sun, S., Liu, M., & Shi, Q. . Short-Term High-Intensity Interval Training on Body Composition and Blood Glucose in Overweight and Obese Young Women. J Diabetes Res. 2016; vol. 2016, Article ID 4073618, 1-9. https://doi.org/10.1155/2016/4073618

Maillard, F., Rousset, S., Pereira, B., Traore, A., de Pradel Del Amaze, P., Boirie, Y., Duclos, M., Boisseau, N. . High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes. Diabetes Metab. 2016; 42(6), 433–441. https://doi.org/10.1016/j.diabet.2016.07.031

Morales-Palomo, F., Ramirez-Jimenez, M., Ortega, J. F., Lopez- Galindo, P. L., Fernandez-Martin, J., & Mora-Rodriguez, R. . Effects of repeated yearly exposure to exercise-training on blood pressure and metabolic syndrome evolution. J Hypertens. 2017; 35(10), 1992–1999. https://doi.org/10.1097/HJH.0000000000001430

Nikseresht, M., Hafezi Ahmadi, M. R., & Hedayati, M. . Detraining- induced alterations in adipokines and cardiometabolic risk factors after nonlinear periodized resistance and aerobic interval training in obese men. Appl Physiol Nutr Metab. 2016; 41(10), 1018–1025.

https://doi.org/10.1139/apnm-2015-0693

Sawyer, B. J., Tucker, W. J., Bhammar, D. M., Ryder, J. R., Sweazea, K. L., & Gaesser, G. A. . Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults. J Appl Physiol. 2016;121(1), 279–288. https://doi.org/10.1152/japplphysiol.00024.2016

Smith-Ryan, A. E., Melvin, M. N., & Wingfield, H. L. . High-intensity interval training: Modulating interval duration in overweight/obese men. Phys Sportsmed. 2015; 43(2), 107–113. https://doi.org/10.1080/00913847.2015.1037231

Smith-Ryan, A. E., Trexler, E. T., Wingfield, H. L., & Blue, M. N. M. . Effects of highintensity interval training on cardiometabolic risk factors in overweight/obese women. J Sports Sci. 2016;34(21), 2038–2046. https://doi.org/10.1080/02640414.2016.1149609

Vella, C. A., Taylor, K., & Drummer, D. . High-intensity interval and moderate-intensity continuous training elicit similar enjoyment and adherence levels in overweight and obese adults. Eur J Sport Sci. 2017;17(9), 1203–1211. https://doi.org/10.1080/17461391.2017.1359679

Zhang, H., Tong, T. K., Qiu, W., Wang, J., Nie, J., & He, Y. . Effect of High-Intensity Interval Training Protocol on Abdominal Fat Reduction in Overweight Chinese Women: a Randomized Controlled Trial. Kinesiology. 2015; 47(1), 57–66.

Christmass, M. A., Dawson, B., & Arthur, P. G. . Effect of work and recovery duration on skeletal muscle oxygenation and fuel use during sustained intermittent exercise.Eur J Appl Physiol Occup Physiol. 1999; 80(5), 436–447. https://doi.org/10.1007/s004210050615

Irving, B. A., Davis, C. K., Brock, D. W., Weltman, J. Y., Swift, D., Barrett, E. J., Gaesser, G.A., Weltman, A. . Effect of exercise training intensity on abdominal visceral fat and body composition. Med Sci Sports Exerc.2008; 40(11), 1863–1874. https://doi.org/10.1249/MSS.0b013e3181801d40

Fisher, G., Brown, A. W., Bohan Brown, M. M., Alcorn, A., Noles, C., Winwood, L.,Resuehr, H., George, B., Allison, D. B. . High intensity interval- vs moderate intensitytraining for improving cardiometabolic health in overweight or obese males: A Randomized controlled trial. PLoS One. 2015;10(10). https://doi.org/10.1371/journal.pone.0138853

Mora-Rodriguez, R., Ortega, J. F., Hamouti, N., Fernandez-Elias, V. E., Cañete Garcia- Prieto, J., Guadalupe-Grau, A., Saborido, A., Martin- Garcia, M., Guio de Prada, M., Martinez-Vizcaino, V. . Time-course effects of aerobic interval training and detraining in patients with metabolic syndrome. Nutr Metab Cardiovasc Dis. 2014; 24(7), 792–798. https://doi.org/10.1016/j.numecd.2014.01.011

Elmer, D. J., Laird, R. H., Barberio, M. D., & Pascoe, D. D. . Inflammatory, lipid, and body composition responses to interval training or moderate aerobic training. Eur J Appl Physiol. 2016; 116(3), 601– 609. https://doi.org/10.1007/s00421-015-3308-4

Francois, M. E., Baldi, J. C., Manning, P. J., Lucas, S. J. E., Hawley, J. A., Williams, M. J. A., & Cotter, J. D. . “Exercise snacks” before meals: A novel strategy to improve glycaemic control in individuals with insulin resistance. Diabetologia. 2014; 57(7), 1437–1445. https://doi.org/10.1007/s00125-014-3244-6

Nie, J., Kong, Z., Baker, J. S., Tong, T. K., Lei, S. H., & Shi, Q. . Acute changes in glycemic homeostasis in response to brief high- intensity intermittent exercise in obese adults. J Exerc Sci Fit. 2012; 10(2), 97–100. https://doi.org/10.1016/j.jesf.2012.10.007

Trost, S. G., Owen, N., Bauman, A. E., Sallis, J. F., & Brown, W. . Correlates of adults’ participation in physical activity: Review and update. Med Sci Sports Exerc. 2002; 34(12),1996-2001. https://doi.org/10.1097/00005768-200212000-00020

Whyte, L. J., Gill, J. M. R., & Cathcart, A. J. . Effect of 2 weeks of sprint interval training on health-related outcomes in sedentary overweight/obese men. Metabolism. 2010; 59(10), 1421–1428. https://doi.org/10.1016/j.metabol.2010.01.002

Hood, M. S., Little, J. P., Tarnopolsky, M. A., Myslik, F., & Gibala, M. J. . Low-volume interval training improves muscle oxidative capacity in sedentary adults. Med Sci Sports Exerc. 2011; 43(10), 1849–1856. https://doi.org/10.1249/MSS.0b013e3182199834

Little, J. P., Gillen, J. B., Percival, M. E., Safdar, A., Tarnopolsky, M. a, Punthakee, Z., Jung, M.E., Gibala, M. J. . Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol (1985). 2011; 111(6), 1554–1560. https://doi.org/10.1152/japplphysiol.00921.2011

Nybo, L., Sundstrup, E., Jakobsen, M. D., Mohr, M., Hornstrup, T., Simonsen, L., Bülow, J., Randers, M.B., Nielsen, J.J., Aagaard, P., Krustrup, P. . High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010; 42(10), 1951–1958. https://doi.org/10.1249/MSS.0b013e3181d99203

Tjønna, A. E., Lee, S. J., Rognmo, Ø., Stølen, T. O., Bye, A., Haram, P. M., Loennechen, J.P., Al-Share, Q.Y., Skogvoll, E., Slørdahl, S.A., Kemi, O.J., Najjar, S.M., Wisløff, U. . Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome. Circulation. 2008; 118(4), 346–354. https://doi.org/10.1161/CIRCULATIONAHA.108.772822

Lewington S, Clarke R, Qizilbash N, Collins R, P. R. . Age-specific relevance of blood pressure to vascular disease in one million people in 61 cohort studies. Prospective Studies Collaboration. Lancet. 2002;360(9349), 1903-1913. https://doi.org/10.1016/s0140- 6736(02)11911-8

Mitranun, W., Deerochanawong, C., Tanaka, H., & Suksom, D. . Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports. 2014; 24(2),69-76. https://doi.org/10.1111/sms.12112

Hollekim-Strand, S. M., Bjørgaas, M. R., Albrektsen, G., Tjønna, A. E., Wisløff, U., & Ingul, C. B. . High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: A randomized controlled trial. J Am Coll Cardiol. 2014; 64(16), 1758-1760. https://doi.org/10.1016/j.jacc.2014.07.971

Karstoft, K., Winding, K., Knudsen, S., Nielsen, J., Thomsen, C., Pedersen, B., & Solomon, T. . The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2013; 36(2), 228–236. https://doi.org/10.2337/dc12-0658.

Lee, D. C., Sui, X., Artero, E. G., Lee, I. M., Church, T. S., McAuley, P. A., Standford, F.C., Kohl, H.W., Blair, S. N. . Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the aerobics center longitudinal study. Circulation. 2011; 124(23), 2483–2490.

McKay, B. R., Paterson, D. H., & Kowalchuk, J. M. . Effect of short- term high-intensity interval training vs. continuous training on O2 uptake kinetics, muscle deoxygenation, and exercise performance. J Appl Physiol (1985). 2009; 107(1), 128–138. https://doi.org/10.1152/japplphysiol.90828.2008

Helgerud, J., Høydal, K., Wang, E., Karlsen, T., Berg, P., Bjerkaas, M., Simonsen, T., Helgesen, C., Hjorth, N., Bach, R., Hoff, J. . Aerobic high-intensity intervals improve V̇O2max more than moderate training. Med Sci Sports Exerc. 2007; 39(4), 665–671. https://doi.org/10.1249/mss.0b013e3180304570

Tjønna, A.E., Stølen, T.O., Bye, A., Volden, M., Slørdahl, S.A., Ødegård, R., Skogvoll, E., Wisløff, U. . Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents.Clin Sci (Lond). 2009; 116(4), 317–326. https://doi.org/10.1042/CS20080249

ACSM guidelines. . ACSM’S Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins. 2017.

Kodama, S. . Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women. JAMA. 2009; 301(19), 2024–2035. https://doi.org/10.1001/jama.2009.681