***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: 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 AIMS We examined the effects of physical activity with or without dietary restriction for 3 months on regional fat and insulin sensitivity and compared the effect of total energy expenditure from all levels of physical activity with that of physical activity energy expenditure from moderate-to-vigorous exercise in obese women with Type 2 diabetes . METHODS In this r and omized , controlled trial , we assessed change of body weight , abdominal visceral fat area , subcutaneous fat area and insulin sensitivity , expressed as K(ITT ) , and monitored total energy expenditure and physical activity energy expenditure using an accelerometer during a 12-week intervention in four groups : control , diet , exercise and diet plus exercise . RESULTS The mean body mass index was 28.0 + /- 2.7 kg/m(2 ) and the mean duration of diabetes was 8 + /- 6 years . Both the diet and diet plus exercise groups showed significant body weight loss compared with the control group ( P < 0.05 ) . However , the visceral fat area was reduced only in the diet and exercise group ( P = 0.017 ) and the subcutaneous fat area was reduced only in the diet group ( P = 0.009 ) . Mean energy intake was an independent determinant of the change in subcutaneous fat area ( P = 0.020 ) and mean total anergy expenditure was an independent determinant of visceral fat area ( P = 0.002 ) . Insulin sensitivity K(ITT ) was associated with physical activity energy expenditure ( P = 0.006 ) , energy intake ( P = 0.047 ) and the change in fructosamine level ( P = 0.016 ) but not with changes in body weight , subcutaneous fat area , visceral fat area or adipokine level . CONCLUSIONS Exercise had an additive effect to dietary restriction on visceral fat reduction . Visceral fat area was associated with total energy expenditure , but insulin sensitivity was associated with physical activity energy expenditure The purpose of this study was to determine the effects of exercise training on ventricular epicardial fat  thickness in obese men and to investigate the relationship of the change in epicardial fat thickness to changes in abdominal fat tissue following exercise training .  Twenty-four obese middle-aged men [ age , 49.4 + /- 9.6 yr ; weight , 87.7 + /- 11.2 kg ; body mass index ( BMI ) , 30.7 + /- 3.3 kg/m(2 ) ; peak oxygen consumption , 28.4 + /- 7.2 ml.kg(-1).min(-1 ) ; means + /- SD ] participated in this study . Each participant completed a 12-wk supervised exercise training program ( 60 - 70 % of the maximal heart rate ; 60 min/day , 3 days/wk ) and underwent a transthoracic echocardiography . The epicardial fat thickness on the free wall of the right ventricle was measured from both parasternal long- and short-axis views . The visceral adipose tissue ( VAT ) and subcutaneous adipose tissues were measured by computed tomography . Following exercise training , the epicardial fat thickness was significantly decreased ( P < 0.001 ) . The percentage change of epicardial fat thickness was twice as high compared with those of waist , BMI , and body weight of original values ( P < 0.05 ) . There was a significant relationship ( r = 0.525 , P = 0.008 ) between changes in the epicardial fat thickness and VAT with exercise training . Stepwise multiple regression analysis revealed that the change in VAT , change in systolic blood pressure , and change in quantitative insulin sensitivity check index were independently related to the change epicardial fat thickness ( P < 0.05 ) . The ventricular epicardial fat thickness is reduced significantly after aerobic exercise training and is associated with a decrease in VAT . These results suggest that aerobic exercise training may be an effective nonpharmacological strategy for decreasing the ventricular epicardial fat thickness and visceral fat area in obese middle-aged men BACKGROUND Little is known about how the intensity of exercise influences cardiovascular fitness and body composition , especially in obese adolescents . OBJECTIVE Our goal was to determine the effects of physical training intensity on the cardiovascular fitness , percentage of body fat ( % BF ) , and visceral adipose tissue ( VAT ) of obese adolescents . DESIGN Obese 13 - 16-y-olds ( n = 80 ) were assigned to 1 ) biweekly lifestyle education ( LSE ) , 2 ) LSE + moderate-intensity physical training , or 3 ) LSE + high-intensity physical training . The intervention lasted 8 mo . Physical training was offered 5 d/wk , and the target energy expenditure for all subjects in physical training groups was 1047 kJ ( 250 kcal)/session . Cardiovascular fitness was measured with a multistage treadmill test , % BF with dual-energy X-ray absorptiometry , and VAT with magnetic resonance imaging . RESULTS The increase in cardiovascular fitness in the high-intensity physical training group , but not in the moderate-intensity group , was significantly greater than that in the LSE alone group ( P = 0.009 ) ; no other comparisons of the 3 groups were significant . Compared with the LSE alone group , a group composed of subjects in both physical training groups combined who attended training sessions > or=2 d/wk showed favorable changes in cardiovascular fitness ( P < 0.001 ) , % BF ( P = 0.001 ) , and VAT ( P = 0.029 ) . We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition . CONCLUSIONS The cardiovascular fitness of obese adolescents was significantly improved by physical training , especially high-intensity physical training . The physical training also reduced both visceral and total-body adiposity , but there was no clear effect of the intensity of physical training BACKGROUND American women aged 25 - 44 y gain 0.5 - 1 kg yearly , most of which is fat . Because few midlife women participate in strength training , this mode of activity may be a novel intervention for preventing age-associated fat increases in this population . OBJECTIVES The primary aim was to assess the efficacy of twice-weekly strength training to avoid increases in percentage body fat and intraabdominal fat . DESIGN A r and omized controlled trial was conducted in an ethnically diverse sample of 164 overweight and obese [ body mass index ( in kg/m2 ) : 25 - 35 ] women aged 25 - 44 y. The treatment group did twice-weekly strength training for 2 y. The st and ard care comparison group was given brochures recommending aerobic exercise . Assessment s at baseline , 1 , and 2 y included intraabdominal fat by computed tomography scan and body fat and fat-free mass by dual-energy X-ray absorptiometry . RESULTS During 2 y , percentage body fat changes were -3.68 + /- 0.99 % for the treatment group and -0.14 + /- 1.04 % for the control group , P = 0.01 . Two-year intraabdominal fat changes were 7.05 + /- 5.07 % for the treatment group and 21.36 + /- 5.34 % for the control group , P = 0.05 . CONCLUSION This study suggests that strength training is an efficacious intervention for preventing percentage body fat increases and attenuating intraabdominal fat increases in overweight and obese premenopausal women . This is relevant to public health efforts for obesity prevention because most weight gain can be assumed to be fat , including abdominal fat BACKGROUND Obesity is a major health problem due , in part , to physical inactivity . The amount of activity needed to prevent weight gain is unknown . OBJECTIVE To determine the effects of different amounts and intensities of exercise training . DESIGN R and omized controlled trial ( February 1999-July 2002 ) . SETTING AND PARTICIPANTS Sedentary , overweight men and women ( aged 40 - 65 years ) with mild to moderate dyslipidemia were recruited from Durham , NC , and surrounding communities . INTERVENTIONS Eight-month exercise program with 3 groups : ( 1 ) high amount/vigorous intensity ( calorically equivalent to approximately 20 miles [ 32.0 km ] of jogging per week at 65%-80 % peak oxygen consumption ) ; ( 2 ) low amount/vigorous intensity ( equivalent to approximately 12 miles [ 19.2 km ] of jogging per week at 65%-80 % ) , and ( 3 ) low amount/moderate intensity ( equivalent to approximately 12 miles [ 19.2 km ] of walking per week at 40%-55 % ) . Subjects were counseled not to change their diet and were encouraged to maintain body weight . MAIN OUTCOME MEASURES Body weight , body composition ( via skinfolds ) , and waist circumference . RESULTS Of 302 subjects screened , 182 met criteria and were r and omized and 120 completed the study . There was a significant ( P<.05 ) dose-response relationship between amount of exercise and amount of weight loss and fat mass loss . The high-amount/vigorous-intensity group lost significantly more body mass ( in mean [ SD ] kilograms ) and fat mass ( in mean [ SD ] kilograms ) ( -2.9 [ 2.8 ] and -4.8 [ 3.0 ] , respectively ) than the low-amount/moderate-intensity group ( -0.9 [ 1.8 ] and -2.0 [ 2.6 ] , respectively ) , the low-amount/vigorous-intensity group ( -0.6 [ 2.0 ] and -2.5 [ 3.4 ] , respectively ) , and the controls ( + 1.0 [ 2.1 ] and + 0.4 [ 3.0 ] , respectively ) . Both low-amount groups had significantly greater improvements than controls but were not different from each other . Compared with controls , all exercise groups significantly decreased abdominal , minimal waist , and hip circumference measurements . There were no significant changes in dietary intake for any group . CONCLUSIONS In nondieting , overweight subjects , the controls gained weight , both low-amount exercise groups lost weight and fat , and the high-amount group lost more of each in a dose-response manner . These findings strongly suggest that , absent changes in diet , a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise . Most individuals can accomplish this by walking 30 minutes every day To examine the influence of moderate-intensity ( 50 % of VO(2peak ) ) exercise training ( MI ) versus high-intensity ( 75 % of VO(2peak ) ) exercise training ( HI ) on regional fat distribution and plasma adiponectin , we r and omized 18 overweight ( body mass index [ BMI ] = 30 + /- 1 kg/m(2 ) ) elderly ( 71 + /- 1 years ) to HI , MI , or a control group ( CON ) . Subjects enrolled in HI or MI completed a 12-week exercise training protocol design ed to expend 1000 kcal/week . Body 
    Output:
    
Aerobic training of moderate or high intensity has the highest potential to reduce visceral adipose tissue in overweight males and females .
These results suggest that an aerobic exercise program , without hypocaloric diet , can show beneficial effects to reduce visceral adipose tissue with more than 30 cm(2 ) ( on CT analysis ) in women and more than 40 cm(2 ) in men , even after 12 weeks