The impact of exercise training compared to caloric restriction on hepatic and peripheral insulin resistance in obesity

Robert H. Coker, Rick H. Williams, Sophie E. Yeo, Patrick M. Kortebein, Don L. Bodenner, Philip A. Kern, William J. Evans

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


Context: It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance. Objective: Utilizing metabolic feeding and supervised exercise training,weexamined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance. Design, Participants, and Intervention: Thirty-four obese, older subjects were randomized to: caloric restriction with weight loss (CR), exercise training with weight loss (EWL), exercise training without weight loss (EX), or controls. Based on an equivalent caloric deficit in EWL and CR, we induced matched weight loss. Subjects in the EX group received caloric compensation. Combined with [6,62H 2]glucose, an octreotide, glucagon, multistage insulin infusion was performed to determine suppression of glucose production (SGP) and insulin-stimulated glucose disposal (ISGD). Computed tomography scans were performed to assess changes in fat distribution. Results: Body weight decreased similarly in EWL and CR, and did not change in EX and controls. The reduction in visceral fat was significantly greater in EWL (-71 ± 15 cm2) compared to CR and EX. The increase in SGP was also almost 3-fold greater (27 ± 2%) in EWL. EWL and CR promoted similar improvements in ISGD [+2.5 ± 0.4 and 2.4 ± 0.9 mg·kg fat-free mass (FFM) -1·min-1], respectively. Conclusions: EWL promoted the most significant reduction in visceral fat and the greatest improvement in SGP. Equivalent increases in ISGD were noted in EWL and CR, whereas EX provided a modest improvement. Based on our results, EWL promoted the optimal intervention-based changes in body fat distribution and systemic insulin resistance.

Original languageEnglish
Pages (from-to)4258-4266
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Issue number11
StatePublished - Nov 2009

Bibliographical note

Funding Information:
This material is based upon work supported in part by the Department of Veterans Affairs, and Health Services Research and Development.

Funding Information:
This work was supported by National Institutes of Health (NIH) Grant KO1 DK 64716-01 (to R.H.C.) and American Heart Association Grant SDA 0335172N (to R.H.C.). We acknowledge the support of the University of Arkansas for Medical Sciences General Clinical Research Center funded through NIH Grant M01 RR14288 .

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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