***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Physical exercise increases peripheral insulin sensitivity , but regional differences are poorly eluci date d in humans . We investigated the effect of aerobic exercise training on insulin-stimulated glucose uptake in five individual femoral muscle groups and four different adipose tissue regions , using dynamic ( femoral region ) and static ( abdominal region ) 2-deoxy-2-[¹⁸F]fluoro-d-glucose ( FDG ) PET/CT methodology during steady-state insulin infusion ( 40 mU·m⁻²·min⁻¹ ) . Body composition was measured by dual X-ray absorptiometry and MRI . Sixty-one healthy , sedentary [ V(O2max ) 36(5 ) ml·kg⁻¹·min⁻¹ ; mean(SD ) ] , moderately overweight [ BMI 28.1(1.8 ) kg/m² ] , young [ age : 30(6 ) yr ] men were r and omized to sedentary living ( CON ; n = 17 completers ) or moderate ( MOD ; 300 kcal/day , n = 18 ) or high ( HIGH ; 600 kcal/day , n = 18 ) dose physical exercise for 11 wk . At baseline , insulin-stimulated glucose uptake was highest in femoral skeletal muscle followed by intraperitoneal visceral adipose tissue ( VAT ) , retroperitoneal VAT , abdominal ( anterior + posterior ) subcutaneous adipose tissue ( SAT ) , and femoral SAT ( P < 0.0001 between tissues ) . Metabolic rate of glucose increased similarly ( ~30 % ) in the two exercise groups in femoral skeletal muscle ( MOD 24[9 , 39 ] μmol·kg⁻¹·min⁻¹ , P = 0.004 ; HIGH 22[9 , 35 ] μmol·kg⁻¹·min⁻¹ , P = 0.003 ) ( mean[95 % CI ] ) and in five individual femoral muscle groups but not in femoral SAT . St and ardized uptake value of FDG decreased ~24 % in anterior abdominal SAT and ~20 % in posterior abdominal SAT compared with CON but not in either intra- or retroperitoneal VAT . Total adipose tissue mass decreased in both exercise groups , and the decrease was distributed equally among subcutaneous and intra-abdominal depots . In conclusion , aerobic exercise training increases insulin-stimulated glucose uptake in skeletal muscle but not in adipose tissue , which demonstrates some interregional differences Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain BACKGROUND AND AIMS Echocardiographic measurement of epicardial fat ( EF ) seems to be a reliable and diagnostic marker of visceral adipose tissue ( VAT ) . However , the weight loss-induced changes in EF have not been compared with those in VAT or the truncal depot . In this study , we aim ed to compare the weight loss-induced changes in EF , VAT and other regional fat compartments in obese men . METHODS AND RESULTS In this study , 27 moderately obese men ( age 45.8+/-1.7 years ; body mass index 30.5+/-0.7 kg/m(2 ) ) followed a daily low-calorie diet  as part of a clinical 12-week weight loss interventional study . We evaluated the EF thickness by transthoracic echocardiography , assessed the abdominal fat tissues by computed tomography scans , and examined the regional and whole body fat compartments by dual X-ray absorptiometry . An average decrease of 26.8 % in the initial calorie intake corresponded to post-program reductions of 17.2 % , 11.0 % , 16.6 % , and 29.8 % in EF thickness ( P<0.001 ) , body mass , percentage fat mass , and abdominal fat compartments , respectively . The percentage change in VAT in response to weight loss was twice as high as the substantial change in EF tissue ( P<0.001 ) . CONCLUSION The results of the study suggest that a low-calorie diet-induced weight loss decreases EF thickness . Moderate diet-induced weight loss alone may represent an effective nonpharmacological strategy for reducing EF , which is a unique , pathogenic fat depot and an emerging marker of VAT OBJECTIVE To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness , body composition , and glycemic control . RESEARCH DESIGN AND METHODS Subjects with type 2 diabetes were r and omized to a control ( n = 8) , continuous-walking ( n = 12 ) , or interval-walking group ( n = 12 ) . Training groups were prescribed five sessions per week ( 60 min/session ) and were controlled with an accelerometer and a heart-rate monitor . Continuous walkers performed all training at moderate intensity , whereas interval walkers alternated 3-min repetitions at low and high intensity . Before and after the 4-month intervention , the following variables were measured : VO2max , body composition , and glycemic control ( fasting glucose , HbA1c , oral glucose tolerance test , and continuous glucose monitoring [ CGM ] ) . RESULTS Training adherence was high ( 89 ± 4 % ) , and training energy expenditure and mean intensity were comparable . VO2max increased 16.1 ± 3.7 % in the interval-walking group ( P < 0.05 ) , whereas no changes were observed in the continuous-walking or control group . Body mass and adiposity ( fat mass and visceral fat ) decreased in the interval-walking group only ( P < 0.05 ) . Glycemic control ( elevated mean CGM glucose levels and increased fasting insulin ) worsened in the control group ( P < 0.05 ) , whereas mean ( P = 0.05 ) and maximum ( P < 0.05 ) CGM glucose levels decreased in the interval-walking group . The continuous walkers showed no changes in glycemic control . CONCLUSIONS Free-living walking training is feasible in type 2 diabetic patients . Continuous walking offsets the deterioration in glycemia seen in the control group , and interval walking is superior to energy expenditure – matched continuous walking for improving physical fitness , body composition , and glycemic control The independent effects of exercise and weight loss on markers of inflammation ( MOI ) in obese individuals have not been clearly characterized . The objectives of this study were to : ( i ) identify the independent effects of exercise and weight loss on MOI and ( ii ) determine whether changes in MOI were associated with changes in fat distribution . Subjects were 126 healthy , premenopausal women , BMI 27 - 30 kg/m(2 ) . They were r and omized to one of three groups : diet only , diet + aerobic- , or diet + resistance training until a BMI < 25 kg/m(2 ) was achieved . Fat distribution was measured with computed tomography , and body composition with dual-energy X-ray absorptiometry .  Serum concentrations of tumor necrosis factor (TNF)-α , soluble TNF receptor 1 ( sTNF-R1 ) , soluble TNF receptor 2 ( sTNF-R2 ) , C-reactive protein ( CRP ) , and interleukin (IL)-6 were assessed . Results of repeated- measures ANOVA indicated a significant effect of time on MOI , such that MOI decreased with weight loss . Results of mixed-model analysis indicated that adjusting for intra-abdominal adipose tissue ( IAAT ) and total fat mass explained the decreases in TNF-α and sTNF-R1 , whereas only total fat mass explained the decreases in sTNF-R2 , IL-6 , and CRP . In conclusion , weight loss was associated with decreases in MOI . The effect of weight loss appeared to be mediated by changes in total fat mass or IAAT . Addition of exercise did not alter the response , suggesting that weight loss has a more profound impact for reducing MOI in overweight women than exercise Obesity is associated with vascular endothelial dysfunction , as indicated by impaired endothelium-dependent dilation . Presently there is no direct evidence that energy intake – restricted weight loss alone improves conduit or resistance artery endothelium-dependent dilation , the mechanisms involved , or whether improvements differ with patient age . A total of 40 overweight or obese ( body mass index : ≥25<40 kg/m2 ) nondiabetic men and women aged 21 to 69 years completed 12 weeks of  reduced energy intake ( n=26 ; 15 male ) or attention control ( n=14 ; 9 male ) and 4 weeks of weight maintenance ( r and omized trial ) . Energy intake restriction  reduced estimated total energy intake ( 33 % ) , body weight ( 10.5 % ) , total and abdominal body fat , plasma leptin , oxidized low-density lipoprotein , and improved several metabolic risk factors . Brachial artery flow-mediated dilation was increased by 30 % ( 6.0±0.7 % versus 7.9±0.7%&Dgr ; ; P=0.01 ; n=17 ) . Peak forearm blood flow during intrabrachial artery infusion of acetylcholine was increased by 26 % ( 16.8±1.4 versus 21.1±1.9 mL/100 mL per minute ; P<0.05 ; n=15 ) ; this was inversely related to the reduction in the abdominal visceral : subcutaneous fat ratio ( r=−0.46 ; P<0.05 ) and was abolished by inhibition of NO synthesis with NG-monomethyl-l-arginine . Improvements in endothelium-dependent dilation were not related to age : mean increases in subjects > 50 years of age were similar to or greater than those < 50 years of age . Energy intake – restricted weight loss alone is an effective intervention for improving peripheral conduit and resistance artery endothelial function in young and older overweight/obese adults . The improvements in resistance artery function are mediated by an increase in NO bioavailability and are related to reductions in abdominal visceral fat This study examined the effects of aerobic exercise without weight loss , a hypocaloric high monounsaturated fat diet , and diet plus exercise ( D+E ) on total abdominal and visceral fat loss in obese postmenopausal women with type 2 diabetes . Thirty-three postmenopausal women ( body mass index , 34.6 + /- 1.9 kg/m(2 ) ) were assigned to one of three interventions : a hypocaloric high monounsaturated fat diet alone , exercise alone ( EX ) , and D+E for 14 wk . Aerobic capacity , body composition , abdominal fat distribution ( magnetic resonance imaging ) , glucose tolerance , and insulin sensitivity were measured pre- and postintervention . Body weight ( approximately 4.5 kg ) and percent body fat ( approximately 5 % ) were decreased ( P < 0.05 ) with the D and D+E intervention , whereas only percent body fat ( approximately 2.3 % ) decreased with EX . Total abdominal fat and sc adipose tissue ( SAT ) were reduced with the D and D+E interventions ( P < 0.05 ) , whereas visceral adipose tissue ( VAT ) decreased with 
    Output:
    
In conclusion , both exercise and diet reduce VAT .
Despite a larger effect of diet on total body weight loss , exercise tends to have superior effects in reducing VAT .
Finally , total body weight loss does not necessarily reflect changes in VAT and may represent a poor marker when evaluating benefits of lifestyle- interventions