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Toward Exercise Guidelines for Optimizing Fat Oxidation During Exercise in Obesity: A Systematic Review and Meta-Regression

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Abstract

Background

Exercise training performed at maximal fat oxidation (FATmax) is an efficient non-pharmacological approach for the management of obesity and its related cardio-metabolic disorders.

Objectives

Therefore, this work aimed to provide exercise intensity guidelines and training volume recommendations for maximizing fat oxidation in patients with obesity.

Methods

A systematic review of original articles published in English, Spanish or French languages was carried out in EBSCOhost, PubMed and Scopus by strictly following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Those studies that analyzed maximal fat oxidation (MFO) and FATmax in patients with obesity (body fat > 25% for men; > 35% for women) by calculating substrate oxidation rates through indirect calorimetry during a graded exercise test with short-duration stages (< 10 min) were selected for quantitative analysis. The accuracy of relative oxygen uptake (% peak oxygen uptake [%\(\dot{V}\)O2peak]) and relative heart rate (% peak heart rate [%HRpeak]) for establishing FATmax reference values was investigated by analyzing their intra-individual and inter-study variation. Moreover, cluster analysis and meta-regression were used for determining the influence of biological factors and methodological procedures on MFO and FATmax.

Results

Sixty-four manuscripts were selected from 146 records; 23 studies only recruited men (n = 465), 14 studies only evaluated women (n = 575), and 27 studies included individuals from both sexes (n = 6434). The majority of the evaluated subjects were middle-aged adults (aged 40–60 y; 84%) with a poor cardiorespiratory fitness (≤ 43 mL·kg−1·min−1; 81%), and the reported MFO ranged from 0.27 to 0.33 g·min−1. The relative heart rate at FATmax (coefficient of variation [CV]: 8.8%) showed a lower intra-individual variation compared with relative oxygen uptake (CV: 17.2%). Furthermore, blood lactate levels at FATmax ranged from 1.3 to 2.7 mmol·L−1 while the speed and power output at FATmax fluctuated from 4 to 5.1 km·h−1 and 42.8–60.2 watts, respectively. Age, body mass index, cardiorespiratory fitness, FATmax, the type of ergometer and the stoichiometric equation used to calculate the MFO independently explained MFO values (R2 = 0.85; p < 0.01). The MFO in adolescents was superior in comparison with MFO observed in young and middle-aged adults. On the other hand, the MFO was higher during treadmill walking in comparison with stationary cycling. Body fat and MFO alone determined 29% of the variation in FATmax (p < 0.01), noting that individuals with body fat > 35% showed a heart rate of 61–66% HRpeak while individuals with < 35% body fat showed a heart rate between 57 and 64% HRpeak. Neither biological sex nor the analytical procedure for computing the fat oxidation kinetics were associated with MFO and FATmax.

Conclusion

Relative heart rate rather than relative oxygen uptake should be used for establishing FATmax reference values in patients with obesity. A heart rate of 61–66% HRpeak should be recommended to patients with > 35% body fat while a heart rate of 57–64% HRpeak should be recommended to patients with body fat < 35%. Moreover, training volume must be higher in adults to achieve a similar fat oxidation compared with adolescents whereas exercising on a treadmill requires a lower training volume to achieve significant fat oxidation in comparison with stationary cycling.

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Acknowledgements

The authors would like to thank Dr Florent Besnier, Dr Ratko Peric, Dr Shaea Alkahtani and Professor Jordi Monferrer who kindly provided supplementary data regarding some of their studies and gave their consent for publication in this review.

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Author notes

  1. Francisco J. Amaro-Gahete and Arnulfo Ramos-Jiménez have contributed equally to this work.

Authors and Affiliations

  1. Department of Chemical Sciences, Biomedical Sciences Institute, Autonomous University of Ciudad Juarez, 32310, Chihuahua, Mexico

    Isaac A. Chávez-Guevara & Arnulfo Ramos-Jiménez

  2. Department of Health Sciences, Biomedical Sciences Institute, Autonomous University of Ciudad Juarez, 32310, Chihuahua, Mexico

    Isaac A. Chávez-Guevara & Arnulfo Ramos-Jiménez

  3. Department of Physiology, Faculty of Medicine, EFFECTS-262 Research Group, University of Granada, 18016, Granada, Spain

    Francisco J. Amaro-Gahete

  4. PROmoting FITness and Health Through Physical Activity Research Group (PROFITH), Department of Physical and Sports Education, Faculty of Sports Science, University of Granada, 18011, Granada, Spain

    Francisco J. Amaro-Gahete

  5. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029, Madrid, Spain

    Francisco J. Amaro-Gahete

  6. Department of Endocrinology and Diabetes, Hôpital Lapeyronie CHRU Montpellier, PHYMEDEXP, Université de Montpellier, Montpellier, France

    Jean Frederic Brun

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Correspondence to Isaac A. Chávez-Guevara or Jean Frederic Brun.

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Funding

IACG was supported by a Ph.D scholarship (859438) from the Consejo Nacional de Ciencia y Tecnología (CONACyT). However, the institution did not participate in the manuscript preparation. No other sources of funding were used to assist in the preparation of this article.

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The authors declare that they have no conflicts of interests relevant to the content of this review.

Availability of data and material

The dataset supporting the findings reported in this review are available upon reasonable request from the lead author.

Author contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by ARJ, IACG and JFB. The first draft of the manuscript was written by IACG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Chávez-Guevara, I.A., Amaro-Gahete, F.J., Ramos-Jiménez, A. et al. Toward Exercise Guidelines for Optimizing Fat Oxidation During Exercise in Obesity: A Systematic Review and Meta-Regression. Sports Med 53, 2399–2416 (2023). https://doi.org/10.1007/s40279-023-01897-y

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