not permitted.

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© 2015 EDIZIONI MINERVA MEDICA The Journal of Sports Medicine and Physical Fitness 2017 March;57(3):278-88
Online version at http://www.minervamedica.it DOI: 10.23736/S0022-4707.16.05857-X

ORIGINAL ARTICLE
EPIDEMIOLOGY AND CLINICAL MEDICINE

Effects of high-impact aerobics vs. low-impact aerobics

and strength training in overweight and obese women
Mohamed SAID 1 *, Ncir LAMYA 2, Nejlaoui OLFA 3, Mansour HAMDA 3

1Department of Physical Education, King Faisal University, Al-Hasa, Saudi Arabia; 2Institute of Sports and Physical Education, Kef,

Tunisia; 3Institute of Sports and Physical Education, Ksar-Said, Tunisia

*Corresponding author: Said Mohamed, Department of Physical Education, King Faisal University, Al-Hasa, Saudi Arabia. E-mail: masaid@kfu.edu.sa

A B S T RAC T
BACKGROUND: Regular exercise is one of the factors determining weight reduction and fat loss, and at the same time it is associated with
important health benefits. The purpose of this study was to compare the effects of two different modalities of exercise on changes in body com-
position, physical fitness, and CVR factors in healthy overweight and obese women.
METHODS: Thirty-two women were randomly assigned in 2 groups: a high-impact aerobics group (HIA, N.=16) and a low-impact aerobics
combined with a strength training program group (LIAS, N.=16). Body weight (BW), body composition, aerobic fitness (AF), speed and agil-
ity, vertical-jump distance (VJ), abdominal muscle endurance (AME), the flexibility of the lower back and hamstrings, heart rate (HR), systolic
(SBP) and diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), HDL-c, LDL-c, apolipoprotein A-I (Apo A-I) and B (Apo
B) were measured at baseline and at the end of the training period.
RESULTS: A significant decrease was noted in all anthropometric variables excepting fat-free mass (FFM) which increased in LIAS group
(P<0.05). Comparisons between groups noted significant differences in favor of HIA group in BW, fat percentage and FM, and in favor of LIAS
group in FFM (P<0.05 for all). DBP, HR, TC, LDL-c, TG, and Apo B significantly decreased, and HDL-c and Apo A-I significantly increased
in both groups. No significant modifications were noted in SBP and glucose concentrations. Significant improvements in all physical fitness
components were also noted in HIA group (P<0.05), however, only the AF, VJ, AME, and the flexibility were improved in LIAS group (P<0.01).
Comparison between groups reported that values related to VJ and AME were higher in LIAS compared to HIA group (P<0.01).
CONCLUSIONS: Our findings noted that a 24-week of HIA or LIAS training improved body composition, physical fitness and CVR factors in
overweight and obese women. Nevertheless, the use of each training method remains tributary to wished effects. In fact, HIA training method
is more effective in body weight reduction and fat loss, however, LIAS training method is more appropriate when the improvement of FFM,
aerobic fitness and muscle strength is claimed.
(Cite this article as: Said M, Lamya N, Olfa N, Hamda M. Effects of high-impact aerobics vs. low-impact aerobics and strength training in overweight
and obese women. J Sports Med Phys Fitness 2017;57:278-88. DOI: 10.23736/S0022-4707.16.05857-X)
Key words: Exercise - Anaerobic threshold - Resistance training - Body composition - Physical fitness - Obesity.

O besity is a serious public health problem in the

world. It has been strongly considered to be associ-
ated with a higher risk of cardiovascular diseases (CVD)
and a loss of self-confidence in men 1 and women.2 Obe-
sity also degrades the ability of exercise performance as
or other proprietary information of the Publisher.
evated risk factors for heart diseases namely circulating
inflammatory factors, insulin resistance, dyslipidemia
and hypertension.4 It has been also demonstrated that
obese individuals display major reduction of physical
fitness including muscle strength, flexibility and aerobic

well as mental, emotional and social interactions.3 The and anaerobic capacity. Moreover, by studying the bio-
association between CVD and obesity may be mediated mechanics and the energy cost of gait in obese individu-
by the connection between high body fat percentage, es- als, Stenholem et al.5 noted that at the same workload,
pecially when associated with low muscle mass, and el- energy expenditure, oxygen consumption and muscle

278 The Journal of Sports Medicine and Physical Fitness March 2017
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
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HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN SAID
strength were more important in obese compared to
normal weight persons, which could limit their physi-
cal performance and therefore affect unfavorably the
economy in terms of health costs, absences from work
and reduced productivity.6 Larsson and Mattsson 7 af-
firmed that discrimination against obese persons were
frequent in the recruitment process and employers were
reticent about their obese employees who were gener-
ally considered less efficient, tire quickly and be prone
to many sickness.
Prospective studies confirmed that weight reduction
was the common goal in the treatment of obesity and
their associated risks. These data reported also that reg-
ular exercise, with or without dieting, was the corner-
stone in the treatment of obesity because it was one of
the factors determining long-term weight maintenance
in weight reduction programs, and at the same time it
was associated with important health benefits.8 Many
of these beneficial effects of chronic physical exercise
occur with increasing age, such as prevention of falls,
better cognitive function, lower risks of heart disease
and cancers. Achieving these benefits may require long
period of regular physical activity. However, other ben-
eficial effects such as weight loss, lower risk factors of
diabetes type 2, cardiovascular diseases and metabolic
syndrome, increased muscular strength and decreased
depressive symptoms and blood pressure require only
few months of physical training.9
Nevertheless, despite the prevalence of obesity and
the existing multiple statements claiming the use of
physical exercise as an effective therapeutic for the
treatment of obesity, the adequacy between the desired
effect and the physical exercise used remains until our
days unclear.10 In fact, although the major health cam-
paigns and the professional health organizations his-
torically focused exercise guidelines on chronic aerobic
exercise to manage weight and prevent health risks,11
recent position statements suggested that resistance 12 or
combined aerobic and resistance training 13 may also be
effective to achieve the same goal. These studies have
proved evidence that repeated high-intensity bouts in-
terspersed by low-intensity bouts could be an effective
method for weight loss and health improvements.12 Wil-
or other proprietary information of the Publisher.
lis et al.10 noted also that 8 months of combined aero-
bic and resistance training reduced fat mass in a same
proportion as solely aerobic training (-1.3 kg for aero-
bic and -1.5 kg for combined). Specifically, Paoli and
Vol. 57 - No. 3 The Journal of Sports Medicine and Physical Fitness 279
Bianco 14 affirmed that combined aerobic and resistance
training may be more beneficial for lean body mass than
resistance or aerobic training alone. This may be due to
the effects of this training method on muscle metabo-
lism and signaling pathways related to insulin. Never-
theless, they suggested that authors should take into ac-
count and give more attention to all exercise variables,
and not to be focused only on the difference between
classic methods of aerobic and resistance training.
Moreover, most of the published studies investigating
the effects of combined training in obese persons have
programmed a succession of aerobic and resistance ses-
sions during the training period, and not a succession of
mixed sessions of aerobic and resistance exercises.3, 10, 13
This could modify collected data due to the existing dif-
ferences between both physiological bases underlying
the two type of combination. Furthermore, these stud-
ies have usually used the same amount of training and
a moderate aerobic exercise for both groups.8, 13 This
could reduce the amount of aerobic training in the com-
bined group, decreasing as a consequence its total en-
ergy expenditure due to energy expenditure associated
with resistance training which is not large.11
Thus, it remains to be determined whether high-
impact aerobics training (exercise intensity from 70 to
85% HRmax) will positively affect body composition,
physical condition and risk factors in overweight and
obese adults, whether 6 months of mixed low-impact
aerobics and strength training will provide additive
improvements in these variables, and whether HIA or
LIAS training is more effective at fat loss and health
improvement?
Materials and methods
A total of 54 healthy sedentary overweight or obese
grade I women were evaluated for potential participa-
tion; 9 subjects presented at least one exclusion criteria
and 13 declined to participate in the study. Exclusion
criteria were diabetes, angina pectoris during the inter-
vention period, myocardial infarction, coronary disease,
uncontrolled hypertension, heart or kidney failure, neu-
rological limitations to exercise. A compliance with the
training program of 80% was also set as a criterion for
completing the study.15 Women who met the eligibility
criteria and agreed to participate in our study (N.=32)
were assigned, according to doctor’s advice, to high-
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
COPYRIGHT 2017 EDIZIONI MINERVA MEDICA
SAID HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN
impact aerobics (HIA group, N.=16, age: 30.58±3.8
years, weight: 84.83±11.29 kg, height: 161.50±7.69
cm) or mixed low-impact aerobics and strength train-
ing program (LIAS group, N.=16, age: 29.66±4.2 years,
weight: 87.71±9.24 kg, height: 163±6.90 cm). All par-
ticipants were informed about possible risks and ben-
efits of the exercises, and signed a consent before the
beginning of the study. All participants were instructed
not to change their nutritional habits.
Study design and ethics
This was a randomized, controlled intervention trial
conducted from January to July 2014. Approval was
received from the Ethical Committee of the ISSEP Kef
Medical Center, and the study conformed to the Declara-
tion of Helsinki. All tests and measurements described
below were performed one day before and one day after
the training period at the same time of the day. All partici-
pants were familiar with the different testing protocols by
having a preliminary attempt for each protocol done dur-
ing the three days preceding the baseline exercise tests.
Anthropometric measurements
Body height, body mass, waist and hip circumfer-
ence, and skinfold thickness were measured for each
participant. Body weight was measured with minimal
clothing to the nearest 0.02 kg using a platform beam
balance (Seca, Hamburg, Germany). Height was mea-
sured with a stadiometer (Holtain, Crymych, Wales,
UK) with an accuracy of 0.1 cm. Skinfolds thickness-
es were measured on the right side of the body using
a Harpenden Skinfold Callipers (Harpenden Caliper,
Baty International, Burgess Hill, England, UK). Waist
and hip circumference were defined according to the
Organization’s data gathering protocol, the waist cir-
cumference was measured at the midpoint between the
lower margin of the last palpable rib and the top of the
iliac crest, using a stretch-resistant tape which provides
a constant tension of 100 g. Hip circumference was mea-
sured around the widest portion of the buttocks. Body
Mass Index (BMI) was determined using the weight and
or other proprietary information of the Publisher.
height according to the formula:
BMI = weight/height2.
Waist-to-hip ratio (WHR) is the ratio of the circum-
ference of the waist to that of the hips. Body fat per-
280 The Journal of Sports Medicine and Physical Fitness March 2017
centage (%F), fat mass (FM) and fat-free mass (FFM)
were determined using a prediction equation specific
for adult.16
Physical fitness
Six variables related to health were recorded for each
subject namely aerobic fitness (AF), speed and agility
(SA), vertical-jump distance, abdominal muscle endur-
ance (AME), and the flexibility of the lower back and
hamstrings. Aerobic fitness was assessed using the Coo-
per Test.17, 18 Participants were asked to run the longest
distance as possible during 12 minutes. Walking is al-
lowed, and the total distance covered is recorded. Speed
and agility were measured using the 10×5-m sprint
test.19 This is a continuous sprint test in which the sub-
ject has to make nine fast turns after finishing every 5
meters. At the end of the 10th turn, the participant has to
cross the finish line. The speed was evaluated by using
two pairs of photocells and reflectors connected with an
electronic timer (Tag Hewer, Marin, Switzerland). The
vertical-jump distance was assessed using the coun-
termovement jump test (CMJ).20, 21 The participant,
starting from an upright standing position, performs a
movement of flexion-extension of her knees and hip to
jump upwards the maximum as possible. The vertical-
jump distance was collected by using an Optojump dis-
positive (Microgate Srl, Bolzano, Italy) connected to a
computer. The abdominal muscle endurance was mea-
sured using the sit-up endurance test conducted over 1
minute period, and the flexibility of the lower back and
hamstrings was assessed using the Sit And Reach Flex-
ibility Test.22 A 15-minute warm-up proceeded the test-
ing period including 5 minutes of running at the pace
chosen by the subjects, followed by relaxing exercises,
5 squats, 5 vertical jumps, and 5 accelerations on 5
metres. Between the two tests were 3 minutes of rest,
and for all tests, except the Cooper test and the 10×5-m
sprint test, subjects performed 3 trials with 60 seconds
of rest between trials, and the best performance record-
ed was used for analysis.
Blood sample analysis
Arriving to the laboratory after an overnight fast, sub-
jects were asked to relax for 15 minutes. Then, heart
rate (HR), systolic blood pressure (SBP) and diastolic
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
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HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN SAID

blood pressure (DBP) were obtained from the right arm
by auscultation using a mercury sphygmomanometer.
Blood samples of approximately 10 mL were also col-
lected by venous puncture in tube without anticoagulant.
A droplet (2 μL) of this blood was used to determine the
level of glucose using an ACCU-CHEK Glucose Read-
er (Roche Diagnostics GmbH, Basel, Switzerland), and
the remaining quantity was centrifuged at 3000 rpm for
15 minutes at 4 °C. To prevent erroneous results due
to the presence of fibrin, centrifugation of samples took
place after complete clot formation. The serum were
withdrawn and stored at -80 °C until analysis performed
at the Biochemical Laboratory of the Military Hospital
of Tunis. Lipid profile and its extension were assessed
using Randox commercial kits (Randox Laboratories,
Crumlin, Northern Ireland, UK) including total choles-
terol (TC), triglyceride (TG), high density lipoprotein-
cholesterol (HDL-c), low density lipoprotein-cholesterol
(LDL-c), apolipoprotein A-I (Apo A-I) and apolipopro-
tein B (Apo B) tests. Randox TC and TG assays were a
colorimetric determinations. Randox HDL and LDL kits
utilize a direct clearance methods. Randox Apo A-I and
B assays are based on an immunoturbidimetric methods.
All reagents were in liquid phase ready-to-use and were
used on TECHNICON RA-1000 Chemistry Analyzer.
1). Each training session started with 5 to 10-minutes
aerobic warm-up routine, followed by the session rou-
tine (40 minutes), and concluded with 5 to 10 minutes’
cool down. Warm-up compound jogging, and stretch-
ing exercises routine for the major muscles of the up-
per and lower limbs. The intensity of the training pro-
gram increased progressively. During the adaptation
period (weeks 1-4) subjects were taught on the exercise
technique. Between the 5th and 14th week the intensity
was increased up to 75% of HRmax (side by side, step
touch, side slot, v-step, grapevine, pivot, cha cha cha,
mambo rock - line dance, diamond step, hamstring-
curl, heel touch, sit-up and push up), and finally during
the period between the 15th and 24th week the intensity
was increased up to 85% of HRmax (fast walking, turn
round, heel side, knee-up, scissors double, hop and
jump, jumping jack, side kick, full turn, double kick).
Polar Analyzer (Polar Electro Oy, Kempele, Finland)
was used to maintain the heart rate at the fixed interval
throughout the session.

Training program
Subjects in two groups performed training 4 times/
week (on Sundays, Mondays, Wednesdays and Fridays)
for 24 weeks at two Sports Centers. To make sure that
the exercise programs were carried out as equal as pos-
sible, all training sessions were conducted by aerobic-
fitness professional trainers, and supervised by study
investigators in our group. The exercise programs were
designed taking into account each subject’s muscle
strength using the one-repetition maximum test (1RM)
for LIAS group, and aerobic capacity using the theoreti-
cal maximum heart rate (220 – age in years) for both
groups. Both volume and intensity of exercise was in-
creased according to the American College of Sports
Medicine recommendations.11
or other proprietary information of the Publisher.

High-impact aerobic
High-impact aerobics involves rhythmic exercises Figure 1.—High-impact aerobic exercise involves a flight phase in
routine in which both feet leave the ground (Figure which both feet leave the ground.

Vol. 57 - No. 3 The Journal of Sports Medicine and Physical Fitness 281
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means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
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(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
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SAID HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN

A B
Figure 2.—During low-impact aerobics at least one (A) or both feet (B) are on the floor at all times.

Low-impact aerobics combined with strength training
program
Each session started with 5 to 10 minutes’ aerobic
warm-up, followed by the training session, and con-
cluded with 5 to 10 minutes’ cool down. The session
routine was composed of 30 minutes of a continuously
rhythmic exercises, followed by 20 minutes of muscle-
strengthening exercises conducted on resistance ma-
chines: leg extension, leg flexion, bench press, shoulder
press, triceps extension, and biceps curl. Sit-ups for the
abdominal muscles were also performed in all sessions.
Rhythmic exercises were performed without any
jumping (Figure 2) (side by side, step touch, side slot,
v-step, grapevine, pivot, cha cha cha, mambo rock - line
dance, diamond step, hamstring-curl, heel touch, sit-
up and push up). The first 4 weeks were reserved to a
or other proprietary information of the Publisher.
strengthening exercises were performed 2 sets/session
with 15 seconds of rest between exercises and 3 minutes
between sets, respectively at 60%, 70% and 80% of the
1RM. The 1RM was measured according to the Kura-
moto and Payne 23 lawfulness:
1RM = [1.06 × lifted weight (kg) +
(0.58 × repetition frequency) – (0.203 × age) – 3.41].
Statistical analysis
Changes in all independent variables were calculated
as the difference between the values after and before
exercise. Results were presented as mean±SD. The dis-
tribution of the data was checked for normality by the
Kolmogorov-Smirnov test. The distribution was not
significantly different from a normal distribution for all

technical learning, then between the 5th and 14th week, measurements. Between baseline and follow-up in each
exercises were carried out at 50-55% of the HRmax, and group paired t-test was used. For studying the effective-
finally between the 15th and 24th week the workload ness of exercise between groups, an independent sam-
was increased up to 60-65% of the HRmax. The muscle- ples t-test was calculated. A Pearson’s correlation test

282 The Journal of Sports Medicine and Physical Fitness March 2017
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means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
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©
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HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN SAID

Table I.—Results of anthropometric measurements at baseline and after 24 weeks of training, and the differences between groups.
HIA group (N.=16) LIAS group (N.=16)
Baseline 24 weeks Change (%) Baseline 24 weeks Change (%)
BW (kg) 84.83±11.29 † 81.09±10.27* -4.74±2.9 87.71±9.24 84.83±10.04* -3.05±2.87 †
WC (cm) 106.91±8.33 † 101.38±12.27* -5.2±3.31 111.38±9.89 105.88±11.79* -5.64±3.81
Height (cm) 116.2±7.65 111.38±8.51* -5.73±3.8 119.24±10.54 113.5±687* -6.94±5.71
BMI (kg/m2) 32.07±3.98 30.81±3.5* -3.97±2.72 33.12±2.04 32.09±3.02* † -3.4±2.7
WHR 0.93±0.06 0.9±0.05* -3.25±0.62 0.94±0.1 0.89±0.12* -3.31±0.21
BF (%) 42.70±4.69 39.30±3.62** -7.11±6.01 43.94±2.07 41.82±3.55* † -4.12±5.8 †
FM (kg) 33.79±7.96 31.05±5.03* -8.09±7.6 35.75±7.8 33.61±6.36* -5.22±6.03 †
FFM (kg) 46.06±7.1 46.52±4.9 +0.85±3.7 47.42±8.32 49.45±6.1* † +3.98±4.2 †
Values are presented as mean ± SD.
BW: body weight; WC: waist circumference; BMI: Body Mass Index; WHR: weight-to-height ratio; BF: body fat; FM: fat mass; FFM: fat-free mass.
Significant difference between baseline and 24-weeks: *P<0.05, **P<0.01.
Significant difference between groups: † P<0.05.

was performed to assess the relation between all param-

eters. We analyzed all statistics with the SPSS v.16.0
and statistical significance was set at P<0.05.

Results
The inter-group difference at baseline was only for
body weight and waist circumference, which were re-
ported to be lower in the HIA group compared to the
LIAS group (Table I). After training, a significant de- A B
crease was noted in all variables excepting fat-free
mass in which a significant increase was noted in LIAS
group (P<0.05). Comparisons inter-group changes
noted significant differences in favor of HIA group in
body weight, body fat and fatty mass, and in favor of
LIAS group in FFM (P<0.05 for all). To illustrate the
changes graphically, means and standard error bars
for these parameters at baseline and after 24 weeks
of training are presented in Figure 3A-D according to C D
training groups. Figure 3.—Body weight (A), body fat (B), fat mass (C), and fat-free mass
Changes in blood pressure, heart rate, glucose, lipid (D) at baseline and after 24 weeks of HIA (white bar) and LIAS (black
bar) training program, and the differences in groups. Values presented
profile and lipoproteins after 24 weeks were present- as mean ± SD. Significant difference between baseline and 24 weeks:
ed in Table II. DBP, HR, TC, LDL-c, TG, and Apo *P<0.05, **P<0.01. Significant difference among groups: ♣P<0.05.
B significantly decreased, and HDL-c and Apo A-I
significantly increased in both groups. No significant
modifications were noted in SBP and glucose concen- SA. When comparing the effectiveness of the two train-
trations. ing program, the gains in CMJ and AME were higher
Changes of physical parameters are shown in Ta- in LIAS group compared to HIA group (P<0.01). A
ble III. After the exercise program, significant im- significant correlation was noted in 1) all subjects in
or other proprietary information of the Publisher.

provements in all variables were noted in HIA group BMI vs AF (r=-4987, P<0.05 for HIA group; r=-05682,
(P<0.05). However, only the AF, CMJ, AME and flex- P<0.02 for LIAS group), 2) HIA group in WC vs. flex-
ibility improved after the training period in the LIAS ibility (r=-0.4869, P<0.05), and 3) LIAS group in BMI
group (P<0.01); No significant change was noted in vs. AME (r=-0.5723, P<0.02). To illustrate graphically

Vol. 57 - No. 3 The Journal of Sports Medicine and Physical Fitness 283
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
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SAID HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN

Table II.—Comparison of blood pressure, heart rate, glucose, lipid profile and lipoproteins between baseline and after 24 weeks of train-
ing, and the differences between groups.
HIA group (N.=16) LIAS group (N.=16)
Baseline 24 weeks Change (%) Baseline 24 weeks Change (%)
SBP (mmHg) 138.18±5.07 136.6±4.55 -1.8±1.06 137.35±3.7 136.46±4.67 -0.98±1.9
DBP (mmHg) 86.50±3.04 83.38±5.06* -3.07±5.2 85.76±2.91 82.03±10.99* -3.31±1.9
HR rest (bpm) 88.41±6.78 86.76±5.37* -1.9±4.9 91.63±5.72 88.38±4.16* -3.6±4.1
Glucose (mg/L) 102.38±4.75 101.2±4.5 -1.6±0.8 106.24±10.2 105.3±10.2 -1.02±0.7
TC (mg/dL) 207.5±14.36 196.5±17.88* -6.75±5.84 203.4±21.40 195.0±19.02* -5.23±4.51
LDL-c (mg/dL) 152.4±15.3 143.6±16.6 * -6.1±4.26 147.7±18.13 140.9±13.25* -5.11±4.2
HDL-c (mg/dL) 47.2±2.7 51.4±3.62** +9.5±5.4 48.4±6.7 52.2±4.5** +8.3±6.3
TG (mg/dL) 133.8±5.1 121.8±8.3** -11.57±5.75 130.7±12.07 119.0±11.68* -10.07±9.53
Apo A-I (mg/dL) 132.06±10.17 141.5±12.3* +9.7±6.39 126.1±11.89 134.1±12.5* † +9.68±4.7
Apo B (mg/dL) 154.5±17.20 146.2±15.18* -6.5±5.94 156.7±15.70 144.9±16.3* -7.06±6.24
Values are presented as mean ± SD.
SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate: TC: total cholesterol; LDL-c: low-density lipoprotein cholesterol; HDL-c: high-density
lipoprotein cholesterol; TG: triglyceride; Apo A-I: apoliprotein A-I; Apo B: apoliprotein B.
Significant difference between baseline and 24-weeks: *P<0.05, **P<0.01.
Significant difference between groups: † P<0.05.

Table III.—Results of physical measurements at baseline and after 24 weeks of training, and the differences between groups.
HIA group (N.=16) LIAS group (N.=16)
Baseline 24 weeks Change (%) Baseline 24 weeks Change (%)
AF (m) 1129.00±358.16 1355.53±389.22* +19.7±5.8 1078.50±201.68 † 1323.00±197.88** +20.7±7.46
SA (s) 21.57±2.54 20.67±2.46* -3.6±4.52 21.66±2.94 21.29±3.48 -1.78±2.32
CMJ (cm) 17.07±4.47 19.18±5.82* +10.3±4.47 16.00±3.62 21.38±3.67** † +29.63±5.09 †
AME (U/min) 18.76±6.49 21.41±7.55* +13.8±11.84 17.14±7.56 25.50±6.43** † +46.58±21.69 †
Flexibility (cm) 1.05±7.30 2.97±8.10* +43.75±17.6 1.10±4.63 2.78±5.82* +49.24±24.17
Values are presented as mean ± SD.
AF: aerobic fitness; SA: speed and agility; CMJ: countermovement jump; AME: abdominal muscle endurance.
Significant difference between baseline and 24-weeks: *P<0.05, **P<0.01.
Significant difference between groups: † P<0.05.

the main changes, means and standard error bars for AF,
CMJ and AME at baseline and after 24 weeks of train-
ing are presented in Figure 4A-C according to the HIA
and LIAS group. As a result, adding a period of strength
training to the low impact aerobics program was more
effective on improving the lower limbs explosive pow-
er and abdominal muscles endurance than high impact
aerobics alone.
Discussion
Comparisons of HIA and LIAS training effect on
body weight and compositions noted a substantial de-
crease in all variables excepting the fat-free mass which
or other proprietary information of the Publisher.
women. The specific indoor cycling protocol was main-
ly aerobic, consisted of 3 sessions/week and character-
ized by a progressive exercise intensity varying the re-
sistance applied to the bikes’ flywheels. Values related
to body weight, fat mass and lean mass were respec-
tively -3.05%, -7.22% and +3.98% for the LIAS group,
and -3.2%, -5% and +2.6% for the Bianco et al. study.8
Sanal et al.13 noted also that 12-week aerobic exercise
or aerobic plus resistance exercise were equally effec-
tive in decreasing BW and FM, whereas, only aerobic
plus resistance exercise increased FFM in adults. Spe-
cifically, adding resistance to aerobic exercise was more
effective on increasing FFM and decreasing FM in men
than aerobic exercise alone, however, it was more effec-

was increased in the LIAS group (P<0.05) but did not tive only on reducing FM of legs in women. Moreover,
change in the HIA group. Results of LIAS group were Schjerve et al.15 by studying the effects of high-inten-
similar to that reported by Bianco et al.8 after 12-weeks sity interval aerobic training (85-95% of HRmax), con-
specific indoor cycling protocol in sedentary overweight tinuous moderate-intensity aerobic training (60-70% of

284 The Journal of Sports Medicine and Physical Fitness March 2017
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HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN SAID
A B
Figure 4.—Aerobic fitness (A),
counter movement jump (B) and
abdominal muscle endurance (C)
at baseline and after 24 weeks of
HIA (white bar) and LIAS (black
bar) training program, and the
differences in groups. Values pre-
sented as mean ± SD. Significant
difference between baseline and
24 weeks: *P<0.05, **P<0.01.
Significant difference among
C groups: ♣P<0.05.
HRmax), and maximal strength training programs (90%
of 1RM) for 12 weeks, 3 times/week noted a small, but
significant, decrease only after moderate-intensity and
high-intensity aerobic training in BW, BMI and BF. No
changes were observed in the strength training group
and in the waist/hip ratio in any of the groups.
Recently, Ho et al.24 noted in a 12-week random-
ized parallel design examining the effects of 30-min of
aerobic, resistance, or combined (15-min aerobic ex-
ercise and 15-min of resistance exercise) training that
the combination exercise gave greater benefits for body
composition and cardio-respiratory fitness than aerobic
and resistance training modalities. Park 25 reported also
that combined training (aerobic training plus muscu-
lar resistance training) was more effective in reducing
visceral fat than food intake restriction only. However,
Willis et al.10 by studying the effects of aerobic and/or
resistance training on body mass and fat mass in over-
weight or obese adults noted that a double amount of
training in combined aerobic and resistance training (3
days/week in aerobic training spaced by 3 days/week
in RT) did not result in a greater loss of fat mass or
body mass over AT (3 days/week). They suggested also
that the use of a specific training mode depended on the
or other proprietary information of the Publisher.
targeted objective: if the exercise routine aimed to in-
crease the muscle mass and strength, a RT program was
required. However, if weight reduction and fat loss was
the goal, AT alone could be the optimal mode to use.
Vol. 57 - No. 3 The Journal of Sports Medicine and Physical Fitness 285
Interestingly, it is important to highlight that adding
muscle-strengthening exercises to a low impact aero-
bics training in the same sessions may reduce weight
mass in the same proportion to that esteemed by the
major health agencies after a same amount of aerobic
training. A significant increase in lean body mass was
also noted, indicating a double effect of this strength
training period. According to Schjerve et al.15 weight
loss depended on the amount of oxidized fat during the
training period, and during the restitution phase. This
latter, compared to aerobic training, is more important
after strength training; the higher the intensity of the ex-
ercise, the higher the fat oxidation post-exercise. It has
also been found that the resting metabolism is higher af-
ter strength training than endurance training with low or
moderate intensity,26 but it is not known whether high-
intensity endurance training yields the same effect on
basal metabolism as strength training.15
It is important to practitioners to understand whether
HIA or LIAS training is better to induce significant mod-
ifications in body composition. Our results indicate that
both methods are effective to reduce weight and could
be adopted in the treatment of overweight and obesity.
Also, it is reported that LIAS training is more powerful
in increasing FFM, while, HIA training is more effec-
tive in decreasing BW, WC and FM. These differences
could be due to the effect of each training mode on lean
body mass and FM, notably the visceral adipose tissue
which is more sensitive to aerobic training compared to
strength training.27
Our study indicates also that, in addition to the benefi-
cial effects on body composition, HIA and LIAS training
improve CVD risk factors such as decreased DBP, HR,
TC, TG, LDL-c and Apo B and increased HDL-c and
Apo A-I in both groups. Numerous studies during the
past decade, in compliance with our findings, highlight-
ed the positive benefits of chronic physical exercise on
health by reducing many risk factors such as BP, CHO,
and type 2 diabetes.28-30 Results of a meta-analysis in-
volving 72 trials, 105 study groups and 3936 participants
demonstrated a decreased SBP and DBP after endurance
training, on average, by 7 and 6 mmHg in hypertensive
individuals and by 3 and 2 mmHg in normotensive in-
dividuals, respectively. Hemodynamic measurements
reported that 4.3% of the decreased blood pressure was
based on a 7.1% reduction in systemic vascular resis-
tance with unchanged cardiac output. A decreased rest-
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means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
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SAID HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN
ing heart rate was also noted, on average, of 4.8 bpm
(95% CI: 3.9-5.7). The 9.3% decrease was counterbal-
anced by a 15.4% increase in stroke volume.28 Iwasaki et
al.29 further reported that heart rate, peak heart rate and
BP significantly decreased after a progressive endurance
training sufficient to allow healthy adults to complete a
marathon. In addition, they suggested that 3 months of
regular aerobic training were sufficient to increase R-
wave-R-wave interval and cardiovascular variability in-
dexes with an augmentation of vagal modulation of HR.
Dynamic resistance training involving repetitive
moderate resistance loads with brief rests training is
also able to reduce blood pressure in people with hy-
pertension 30 or in healthy sedentary normotensive or
hypertensive adults.28, 30 Nevertheless, in a comparison
of aerobic versus resistance exercise training effects in
overweight and obese subjects, Bateman et al.31 noted
that diastolic blood pressure and mean arterial pres-
sure decreased significantly with combined training
but failed to change with aerobic training or resistance
training alone.
As with heart rate and blood pressure, studies have
demonstrated a positive effect for chronic physical ex-
ercise on plasma lipids and lipoproteins levels in adults.
Donnelly et al.32 noted in a meta-analysis that aerobic
training increased HDL-c on average by 5% and, with
less consistency, decreased LDL-c and TG on average
by 5 and 4%, respectively. Similarly, resistance training
improved significantly TC (3-16% reduction), LDL-c
(5-39% reduction) and HDL-c (14-27% increase). In
a synthesis of 29 studies representing 1329 men and
women, published between 1955 and 2007 and relating
to the impact of resistance training on lipids and lipo-
proteins in adults, Kelly et al.33 noted significant im-
provements in TC (-5.5 mg/dL), TC/HDL-c (-0.5 mg/
dL), non-HDL-c (-8.7 mg/dL), LDL-c (-6.1 mg/dL) and
TG (-8.1 mg/dL) but not HDL-c (0.7 mg/dL). David et
al.34 reported also that Apo B significantly decreased
and Apo A-I increased after 12-16 weeks of aerobic
training, using 60-80% of VO2peak with 30-60 minutes
a day. Furthermore, Park et al.35 reported that TC, TG,
LDL-c and Apo B significantly decreased, and HDL-c
and Apo A-I significantly increased through 24 weeks
or other proprietary information of the Publisher.
of combined training, 60 minutes a day for 6 days/week
(3 days of aerobic training at 60-70% HRmax and 3 days
of progressive resistance exercise on machines).
In the literature, many studies have examined the
286 The Journal of Sports Medicine and Physical Fitness March 2017
combined effect of obesity and physical training on the
mobility in overweight and obese adults, however, only
few of them have studied the effect of chronic exercise
and obesity on the level of their physical fitness. To our
knowledge this study represents the first exhaustive ran-
domized trial which examines changes in body compo-
sition, CVD risk factors and the level of physical fitness
component induced by comparable amounts of intense
aerobic training and moderate aerobic training associ-
ated to muscle-strengthening exercises, in overweight
and obese women.
Results of this study demonstrated that both HIA and
LIAS training increased physical fitness level. These
adaptations depended, in large part, on the type of the
chronic exercise used. In fact, a significant improve-
ment was noted in all component of physical fitness in
HIA group, however, LIAS training has improved only
the aerobic fitness, the dynamic maximal muscle power
of lower limbs, and the abdominal muscle strength and
endurance. These parameters were more important in
LIAS than in HIA group (Table IV). Referred to specific
reference values, the level of the physical fitness of our
subjects remained poor to average,36 however, the sig-
nificant correlations recorded between physical fitness
components and body composition proved that weight
reduction and fat loss may improve the physical fitness
level in overweight and obese women.37 Thus, diet re-
striction associated to these training programs could
be also effective to improve physical fitness due to the
spectacular results observed after each slimming process
based on caloric restriction and physical training.20, 38
Our results concur with previous studies that claim
chronic exercise of high and/or low intensity improved
physical fitness in sedentary, overweight, and obese
subjects.39 These authors noted that 12 weeks of a self-
selected intensity aerobic training for 30 minutes/day,
3 times/week can improve the physical fitness of obese
women. Gist et al.40 noted also that maximal effort dur-
ing short periods of activity increased aerobic capacity
(+8% in VO2max) in sedentary subjects, and no differ-
ence noted with endurance training group.
Resistance training mainly when associated to caloric
restriction has also great potential to improve physi-
cal fitness, prevent sarcopenia, and limit disabilities in
obese subjects.41 Relevant studies noted that the muscles
of obese individuals responded very well to resistance
chronic exercises which improve FFM and muscular
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
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HIGH- VS. LOW-IMPACT AEROBICS IN OVERWEIGHT WOMEN SAID
power and thus increased the independence of these in-
dividuals and improved their quality of life.39, 41 Dao
et al.20 reported after 6-12 months of moderate dietary
restriction combined with progressive submaximal
physical activity in 55 severely obese adolescents (33
girls and 22 boys) an improvement in handgrip strength,
vertical jump height and HRmax in girls, and in handgrip
strength, vertical jump height, maximal aerobic power,
VO2max, and oxygen pulse in boys. These authors noted
also that the total lean mass was the strongest determi-
nant of these parameters in both sexes.
Limitations of the study
Compared to other studies, the small sample size
was a study limitation, this may under-powered the de-
tection of significant changes in some variables. Also,
along this study, we were reliant to the participant hon-
esty and accuracy in their self-reported information re-
garding their nutritional habits. Monitoring the energy
intake and the energy expenditure in all groups over the
course of the intervention may have contributed to bet-
ter understand all changes recorded. Another limitation
was the use of different training modes and distinct ex-
ercise tests which impaired the comparison of our re-
sults with those of other researchers. Lastly, in the LIAS
group we could not evaluate the effects of the strength
training alone. This could be accomplished by compar-
ing a LIAS training program similar to that used in the
present study, to a similar period in LIA training pro-
gram alone. This would allow a more direct comparison
of the strength training benefits, which are specific to
strength improvement and muscle mass increase, and
the low impact aerobics training benefits, which are
specific to weight reduce and fat loss.
Conclusions
In conclusion, the main findings of our study demon-
strate that a 24-week of HIA or LIAS training reduced
body weight, fat mass and CVD risks in overweight and
obese women. HIA training improved also aerobic fit-
ness, agility, muscle strength, and flexibility, however,
or other proprietary information of the Publisher.
LIAS mode increased only aerobic fitness and muscle
strength. In addition, the intergroup comparisons noted
that the use of each training method remains tributary
to wished effects. In fact, HIA training method is more
Vol. 57 - No. 3 The Journal of Sports Medicine and Physical Fitness 287
effective in body weight reduction and fat loss, how-
ever, LIAS training method is more appropriate when
the improvement of FFM, aerobic fitness and muscle
strength is claimed.
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(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
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Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Acknowledgements.—The authors wish to thank M. Ammari Hsen for the help provided.
Article first published online: November 26, 2015. - Manuscript accepted: November 25, 2015. - Manuscript revised: October 30, 2015. - Manuscript re-
ceived: May 23, 2015.
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