Table 1 Characteristics of Included Studies in the Aerobic Exercise and HIV Systematic Review (n = 24)

Agostini (2009)^a [34]

Randomized combined AER + PRE versus diet and aerobic exercise recommendation (no exercise) [2 groups]

CONSTANT AEROBIC + PRE + DIET versus DIET and EXERCISE RECOMMENDATION ONLY

76

39 %

100 %

70

6/76 (8 %)

EXERCISE (PRE + AER) + CONTROLLED DIET INTERVENTION GROUP: Participants placed on a systematic and controlled diet and physical exerciser (aerobic activity of moderate intensity). Aerobic: walking on a treadmill for 40 min, run 30 min and stair climb for 15 min. Anaerobic components included: 40 min of PRE weight training in arms and legs; 10 cycles 3 repetitions. PRE: 2 kg for women and 5 kg for men. Cool Down and Relaxation: 5 min.

Intensity: Medium intensity

DIET and AEROBIC EXERCISE RECOMMENDATION GROUP (CONTROL): Participants were given advice to follow a standard diet and physical exercise plan according to current recommendations.

70 min; 3X per week for 48 weeks

NR

NR

Baigis (2002) [50]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC versus NON-EXERCISING CONTROL

123

20 %

NR

69

54/123 (44 %)

EXERCISE INTERVENTION GROUP: Ski machine. 40 min total: 5 min stretching, 5 min warm-up on machine, 20 min constant aerobic exercise at 75–85 % HRmax followed by 5 min cool-down and 5 min stretching.

NON-EXERCISING CONTROL: No detailed information.

40 min; 3X per week for 15 weeks

Home

Supervised

Balasubramanyam (2011)^a [33]

Randomized trial with five comparison groups

1) DIET+ EXERCISE (lifestyle change) plus 2 placebos versus

2) DIET + EXERICSE combined with niacin and fenofibrate versus

3) DIET + EXERCISE + niacin only plus 1 placebo versus

4) DIET + EXERCISE + fenofibrate only plus 1 placebo versus

5) USUAL CARE (with 2 placebos). [5 groups]

^b Note for this systematic review we compared Group 1 (exercise + diet) to Group 5 (usual care).

CONSTANT AEROBIC + PRE + DIET versus DIET and EXERCISE RECOMMENDATION ONLY

191 (with dyslipidemia)

13 %

100 %

128

63/191 (33 %)

DIET + EXERCISE INTERVENTION GROUP: Diet Intervention: Participants were taught a weight-maintaining diet.

Exercise Intervention: Participants engaged in an exercise program following ACSM guidelines. Aerobic: Participants began with 10 min stretching and 5 min warm-up; followed by 20–25 min of aerobic exercises (stationary bike and ergometer) at intensity of 70–85 % maximal heart rate or 60–80 % HR reserve, followed by 5–10 min cool down period.

Intensity was measured using the modified Borg Rate of Perceived Exertion (RPE) scale.

PRE: Resistive exercises were performed for 45–50 min; three sets of 8–12 repetitions with a rest break of 1–3 min between each set; followed by 5–10 min cool down.

Intensity: 60–80 % 1 repetition maximum (1RM) of leg and bench press. After a given weight was lifted 8–12 times until muscular failure (unable to complete additional repetitions).

Study trainers provided exercise plans to participants in this alternate program and reviewed their progress biweekly.

DIET AND EXERCISE RECOMMENDATION ONLY (USUAL CARE)Participants received general advice on a heart healthy diet, kept a 7 day food record and received feedback on their caloric intake during a single baseline visit. Participants received a copy of “The Activity Pyramid” recommended by ACSM.

75-90 min; 3X per week for 24 weeks

Study gym

Supervised

Dolan (2006) [51]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC + PRE versus NON-EXERCISING CONTROL

40 (with self-reported and physical evidence of changes in fat distribution)

100 %

82 % taking ARVs (unclear whether it was cART)

38

2/40 (5 %)

INTERVENTION GROUP (Aerobic + PRE Exercise): Combined PRE and aerobic exercise for 2 h total.

Aerobic: 5 min warm-up on stationary bike at 50 % estimated HRmax, followed by standard flexibility routine and aerobic and PRE exercise according to ACSM guidelines followed by a cool down period.

PRE: concentric and eccentric phases of 6 selected upper and lower body muscle groups; Week 1: 3 sets of 10 reps for each muscle group at 60 % 1-RM, 3–5 s between reps rest, 2 min rest between sets, 4 min rest between muscle groups; week 3–16: 4 sets of 8 reps for each muscle group at 70 % 1-RM (Week 2–3), and 80 % 1-RM (week 4–16), 2–3 s between reps rest, 1 min rest between sets, 2 min rest between muscle groups. Each repetition lasted 6–10 s each.

NON-EXERCISING CONTROL GROUP: Usual care

120 min; 3X per week for 16 weeks

Home

Supervised

Driscoll (2004a) [44]

Randomized combined exercise and metformin and metformin-only group [2 groups]

CONSTANT AEROBIC + PRE + METFORMIN versus METFORMIN ONLY

37 (evidence of fat redistribution and hyperinsulinemia)

20 %

100 %

25

12/37 (32 %)

INTERVENTION GROUP (Exercise + Metformin): Constant aerobic exercise followed by resistive training. Aerobic: 20 min aerobic exercise on stationary cycle at 60 % HRmax (week 1–2) and progressing to 30 min at 75 % HRmax (week 3–12) according to ACSM guidelines, 5 min warm-up on stationary bike, standard flexibility routine, followed by resistance training.

PRE: of 3 sets of 10 repetitions for every muscle group, resting 2–3 s between repetitions, 2 min between sets, and 4 min between muscle group. Week 1: initial intensity of PRE was 60 % 1-RM; week 2–4 intensity increased to 70 % 1-RM; week 4–12 intensity of 80 % 1-RM. 1-RM was measured every other week and load adjusted to maintain relative intensity at 80 % 1-RM.

METFORMIN ONLY GROUP: 500 mg of metformin twice per day, with a dose increase to 850 mg twice a day (week 2–12).

Total exercise time unknown (20-30 min aerobic;plus unknown duration of(PRE); Additional minutes (PRE); 3X per week for 12 weeks.

Hospital

Supervised

Farinatti (2010)^a [32]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC + PRE versus NON-EXERCISING CONTROL

27

NR

100 %

27

0/27 (0 %)

INTERVENTION GROUP (Aerobic + PRE Exercise): Each 90 min session included aerobic, resistance and flexibility exercises.

Constant Aerobic Exercise: cyclo-ergometer for 30 min at moderate intensity. PRE: 3 sets of 12 reps of 5 exercises at 60–80 % 12-RM. 1st week - 3 sets of 21 repetitions at 60 % 12 repetition maximum (12 RM) for all exercises. remaining weeks, the workload was 80 % of 12-RM for the following exercises: leg press, bench press, knee extension, seated bilateral row, abdominal sit-ups with rest intervals of 2–3 min between sets and exercises. Flexibility: 10 min - 2 sets of 30 s at maximal range of motion of 8 exercises (involving all major joints).

NON-EXERCISING CONTROL GROUP: No intervention.

90 min; 3X per week for 12 weeks

NR

Supervised

Fitch (2012)^a [31]

Randomized trial: 1) exercise (lifestyle modification - LSM) and placebo (EXERCISE ONLY) versus 2) exercise (lifestyle modification) + metformin (EXERCISE + METFORMIN) versus 3) no LSM and metformin only (METFORMIN ONLY) versus 4) CONTROL (no LSM and placebo) [4 groups]

CONSTANT AEROBIC + PRE VERSUS NON-EXERCISING CONTROL; and

CONSTANT AEROBIC + PRE + METFORMIN versus METFORMIN ONLY

50 (with metabolic syndrome)

24 %

100 %

36

14/50 (28 %)

INTERVENTION GROUP - EXERCISE (LIFESTYLE MODIFICATION): Included exercise 3 times per week (supervised) with dietary counselling once per week.

Aerobic: Warm up was 5 min of stationary bike at 50 % maximum heart rate (220 minus age). Aerobic training was performed using a stationary cycle - each participant exercised for 20 min at 60 % their maximal HR (220-age) for the first 2 weeks followed by 30 min at 75 % their maximal heart rate for the duration of the study. [20 min total]

PRE: The aerobic training was followed by 30 min of PRE on equipment. Exercises included: leg press, chest press, knee extension, lateral pull down, knee flexion, and triceps dip. Participants performed 3 sets of 10 reps for each exercise, their effort was increased over 6 months from 60 to 80 % of their 1RM. For those unable to reach 80 % 1RM the resistance was increased as tolerated. [30 min total]

Dietary Counseling: Investigators covered a core curriculum modelled after a diabetes prevention program. The initial core sessions were completed within the first 18 weeks with review and reinforcement for the remainder of the study.

EXERCISE (LSM) + METFORMIN GROUP: Exercise (or LSM) as per above plus 500 mg of metformin twice a day with a dose increase to 850 mg twice a day after 3 months.

50 min total (20 min aerobic; 30 min PRE); 3X per week for 52 weeks

NR

Supervised

Grinspoon (2000) [42]

Randomized trial with 4 comparison groups: 1) PRE + AEROBIC versus 2) PRE + AEROBIC + Testosterone versus 3) Testosterone only versus 4) Control [4 groups]

CONSTANT AEROBIC + PRE versus NON–EXERCISING CONTROL

54 (with AIDS–related wasting)

0 %

72 %

43

11/54 (20 %)

[4/26 (15 %) from the 2 comparison groups of interest; groups 1 and 4]

INTERVENTION EXERCISE GROUP: Supervised progressive strength training and constant aerobic conditioning. Aerobic: 20 min aerobic exercise on stationary cycle at 60–70 % HRmax, 15 min cool-down followed by resistance training. PRE: performed isotonically on computerized equipment and included: leg extension, leg curl, leg press, latissimus doris pull-down, arm curl, and triceps extension. 1-RM weight was established at baseline. Intensity: Participants increased resistance as follows: weeks 1 and 2, 2 sets at 8 repetitions per set, 60 % 1-RM; weeks 3 to 6, 2 sets, 8 repetitions per set, 70 % 1-RM; weeks 7 to 12, 3 sets, 8 repetitions per set, 80 % 1-RM.

Total exercise time unknown (20 aerobic + 15 cool-down + unknown duration of PRE) 3x per week for 12 weeks

NR

Supervised

LaPerriere (1990) [36]

Randomized exercise and control groups [2 groups]

INTERVAL AEROBIC versus NON-EXERCISING CONTROL

50 gay men (unknown % who were HIV positive)^c

0 %

NR

17 HIV positive participants

NR

INTERVENTION GROUP: Stationary bike 45 min total @ 80 % HRmax for 3 min, then @ 60–79 % HRmax for 2 min.

NON-EXERCISING CONTROL GROUP: Usual care

45 min; 3X per week for 5 weeks

NR

NR

Lindegaard (2008)^a [30]

Randomized trial of aerobic versus progressive resistive exercise [2 groups]

INTERVAL AEROBIC versus PRE

20 (with dyslipidemia, lipodystrophy)

0 %

100 %

18

2/20 (10 %)

AEROBIC EXERCISE GROUP: Aerobic exercise consisted of 8 different programs with 35 min of interval training. 5 min warm-up. Intensity varied from 50–100 % VO2max. The first 8 weeks the mean intensity was targeted at 65 % VO2max and the last 8 weeks were targeted to 75 % of VO2max.

PRE (RESISTANCE) EXERCISE GROUP: PRE consisted of 8 exercises (leg curl, pull down, seated leg press, chest press, seated rows, leg extension, abdominal crunch and back extension) in resistance training machines for 45–60 min. The # of repetitions and sets changed every week. and the resting interval was 60–120 s.

Aerobic Session (35 min); PRE Session (45–60 min); 3X per week for 16 weeks

Public Fitness Centre

Supervised

Lox (1995) [38]

Randomized to two exercise groups (PRE and aerobic) and one control group [3 groups]

CONSTANT AEROBIC versus PRE versus NON-EXERCISING CONTROL^b

22 (aerobic and control groups only)

0 %

100 % (taking some form of ARV therapy that may or may not have been in combination)

21

1/22 (4 %)

INTERVENTION GROUP (AEROBIC): Stationary bike, 45 min total: 5 min warm-up (stretching), 24 min cycle ergometer at 50–60 % heart rate reserve (HRR), 15 min cool-down.

INTERVENTION GROUP (PRE): 45 min total. Isotonic resistance to major muscle groups in legs, arms and upper body. Resistance was initiated at 60 % of an individual’s 1-RM and increased by either 5 or 10 lb at a time after successful performing 3 sets of 10 reps at constant weight.

45 min total; 3X per week for 12 weeks

NR

Supervised

MacArthur (1993) [53]

Randomised to two exercise intervention groups [2 groups]

INTERVAL AEROBIC (HIGH versus LOW INTENSITY)

25

4 %

100 % taking ARV therapy but unclear how many were on combination ART.

6 (analysis based on those compliant with exercise program’ only

19/25 (76 %)

HIGH INTENSITY EXERCISE-INTERVENTION GROUP: High intensity exercise: 24 min total @75–85 % V02max x 4 min x 6 intervals.

LOW INTENSITY EXERCISE INTERVENTION GROUP: Low intensity exercise: 40 min total @50–60 % V02max x 10 min x 4 intervals. Exercise included walking, jogging, biking, rowing and stair-stepping.

3X per week for 24 weeks

NR

NR

Maharaj (2011)^a [29]

Randomized trial comparing exercise versus non-exercising control [2 groups]

CONSTANT AEROBIC versus NON-EXERCISING CONTROL

52

35 %

100 %

36

16/52 (31 %)

AEROBIC EXERCISE (INCLUDING HOME EXERCISE) GROUP: Participants were informed that they were to perform 20 min of cycling on a cycle ergometer, followed by 20 min of walking on a treadmill. This was followed by a home program of exercises and participants were shown how to monitor their respiratory, heart, and blood pressure at home. Home protocol = 10 min each of brisk walking, squatting with hands on the hips and jogging on the spot three times per week (total of 30 min). Intensity of Aerobic Exercise: Minimal resistance for 2 sessions of 10 min of cycling and 5 min of rest. This was followed by 2 sessions of 10 min of treadmill walking on a motorized treadmill with 5 min of rest (Modified Bruce protocol was used). Moderate Intensity included 50–70 % of age-predicted maximum heart rate (220 age in years) with heart rate maximum set within 10 beats of this percentage predicted maximum.

NON-EXERCISING CONTROL GROUP: Participants received 20 min of minimal heat therapy to their thigh muscles of each leg by means of a shortwave machine. Home Protocol = reading a magazine at home for 30 min, 3 times per week.

Total of 40 min exercise and 20 min rest (Centre protocol) and total of 30 min (Home protocol); 4X per week (3X at home; 1X at centre) for 12 weeks

Rehabilitation Centre (1X per week) and Home (3X per week)

Supervised 1X per week at rehabilitation centre. Home protocol not supervised.

Mutimura (2008a) [45]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC versus NON-EXERCISING CONTROL

100 (with moderate to severe body fat redistribution)

60 %

100 %

97

3/100 (3 %)

INTERVENTION GROUP (Aerobic Exercise): Six month supervised exercise programme at a fitness club in Kigali, Rwanda. Aerobic Exercise: ‘proper warm up’, stretching, and 15 min of brisk walking, followed by 45–60 min of jogging, running, stair climbing, low-back and abdominal stabilization and strengthening exercises, followed by a 15 min cool down and stretching exercises. Intensity: Gradual progression to encourage participants to perform jogging and running with the goal of achieving at least 45 % maximum heart rate (Weeks 1–3), 60 % maximum heart rate (Weeks 3–8), and 75 % maximum heart rate (Weeks 8–24).

NON-EXERCISING CONTROL GROUP: No intervention

3X per week, (90 min per session, alternating days) for 24 weeks

Fitness club

Supervised

Ogalha (2011)^a [28]

Randomized exercise and control group [2 groups]

AEROBIC + PRE + NUTRITION COUNSELING versus NUTRITION COUNSELING ALONE (CONTROL)

70 (lipodystrophy in 54 % of participants)

46 %

100 %

63

7/70 (10 %)

EXERCISE + NUTRITIONAL COUNSELING (INTERVENTION) GROUP: Participants engaged in 1 h supervised gym class 3 times per week plus monthly dietary counseling by a nutrition specialist. Intensity of exercise was 75 % maximum heart rate.

NUTRITIONAL COUNSELING (MONTHLY) NON-EXERCISING CONTROL GROUP: Monthly dietary counselling by a nutrition specialist. Counseling sessions included 50 min discussion on dietary needs and recommendations. Participants also received a 30 min orientation on the importance of regular physical activities and how to include them in their daily routine. They were stimulated to perform activities like running, biking or walking for 1 h at least 3 times per week.

3X per week for 24 weeks

Fitness centre

Supervised

Perez-Moreno (2007)^a [27]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC + PRE versus NON-EXERCISING CONTROL

27 (prison inmates living with Hepatitis C co-infection)

0 %

10 %

19

8/27 (30 %)

EXERCISE (AEROBIC + PRE) INTERVENTION GROUP: 3 weekly sessions of 90-min duration each. Each session started and ended with a 10-min warm-up and cool-down period, respectively, consisting of cycle ergometer pedalling at very light workloads and stretching exercises for all major muscle groups. The 70-min core portion of the training session was divided into resistance and aerobic training.

PRE: Resistance training included 11 exercises engaging 11 major muscle groups. Stretching exercises: involved an exercise performed at the end of each set of resistance exercise.

In month 1, participants performed two and one set of exercises for large and small muscle groups and all sets were performed at a resistance that allowed 12–15 repetitions. Then, the resistance used was individually adjusted to allow the completion of 8–10 repetitions for three sets of the large muscle group exercises and two sets of the small muscle group exercises. The resistance used for each exercise was increased by 5–10 % when the participant could perform the prescribed maximal repetitions per set. After an increase in resistance, the repetitions per set typically decreased to the low end of the prescribed repetition range (12 or 8 repetitions). Abdominal crunches and low back extensions were performed in two sets of 15–20 repetitions at the start of the program and in three sets of 20 repetitions at the end.

Aerobic Exercise: At the beginning of the program, aerobic training consisted of pedalling on a cycle ergometer for 20 min at 70 % of the age-predicted maximum heart rate. The duration and intensity of the sessions were gradually increased during the 4-month period so that participants completed 45 min of continuous pedalling at 80 % of HRmax by the end of the training program. For participants in the poorest physical condition, it was sometimes necessary to divide the first sessions into shorter time intervals to complete the total 20-min target duration.

NON-EXERCISING CONTROL GROUP: Participants followed their usual sedentary lifestyle (physical activity level < 2; walking for a total of 30–60 min three days per week) and performing no strenuous exercise such as running, cycling, swimming or resistance training.

135 min total (PRE+Aerobic plus warm up and cool-down); 3X per week for 16 weeks

Prison

Supervised

Perna (1999) [48]

Randomized exercise and control groups [2 groups]

INTERVAL AEROBIC versus NON-EXERCISING CONTROL

43

36 %

No participants were taking protease inhibitors but may have been taking other forms of ARV therapy

28

15/43 (35 %)

INTERVENTION GROUP: Stationary bike 45 min total @ 70–80%HR max x 3 min then 2 min “off” (10 min stretch pre and post).

NON-EXERCISING CONTROL GROUP: Usual care

45 min total; 3 x per week for 12 weeks

NR

Supervised

Rigsby (1992) [47]

Randomized exercise and control (counselling) groups [2 groups]

CONSTANT AEROBIC + PRE versus NON-EXERCISING CONTROL

45 (37 HIV+)

0 %

NR

31 (24 HIV+)

13/37 (35 %)

INTERVENTION GROUP: Stationary bike 60 min total @60–80 % HRreserve x 20 min (2 min warm-up and 3 min cool down at low intensity.) Stretching x 10–15 min. Strengthening x 20–25 min.

NON-EXERCISING CONTROL GROUP: Received 90–120 min of counselling 1–2 times per week for 12 weeks.

3X per week for 12 weeks

NR

Supervised

Smith (2001) [40]

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC versus NON-EXERCISING CONTROL

60

13 %

23 %

49

11/60 (18 %)

INTERVENTION GROUP: Minimum of 30 min constant aerobic exercise at 60–80 % V02 max consisting of mandatory 20 min walking/jogging on treadmill and remaining time spent either on stationary bicycle, stair stepper or cross-country machine.

NON-EXERCISING CONTROL GROUP: Usual care

3x per week for 12 weeks

Exercise facility at medical centre

Supervised

Stringer (1998) [49]

Randomized to two exercise intervention groups and one control group [3 groups]

CONSTANT AEROBIC versus NON-EXERCISING CONTROL

34

11 %

94 %

26

8/34 (24 %)

MODERATE INTENTSITY (INTERVENTION #1): stationary cycle ergometer @ 80 % LAT x 60 min.

HEAVY INTENSITY (INTERVENTION #2): stationary cycle ergometer @ 50 % of difference between Lactic Acid Threshold (LAT) and VO2 max x 30–40 min.

NON-EXERCISING CONTROL GROUP: Usual care

3 x per week for 6 weeks

NR

NR

Terry (1999) [54]

Randomized to two exercise intervention groups [2 groups]

CONSTANT AEROBIC (MODERATE versus HEAVY INTENSITY)

31

33 %

NR

21

10/31 (32 %)

MODERATE INTENSITY (INTERVENTION #1): Moderate exercise: walking @55–60 % HRmax x 30 min (5 min @ target intensity, 1 min recovery.) (15 min stretch pre and post)

HIGH INTENSITY (INTERVENTION #2): High exercise: running @75–85 % HRmax x 30 min (5 min @ target intensity, 1 min recovery) (15 min stretch pre and post)

Exercise included walking, running and stretching.

3 x per week for 12 weeks

NR

NR

Terry (2006) [52]

Randomized to two groups (aerobic exercise + low lipid diet versus low lipid diet only) [2 groups]

CONSTANT AEROBIC + LOW LIPID DIET versus LOW LIPID DIET ONLY

42 (with hyperlipidemia)

33 %

100 %

30

12/42 (28 %)

INTERVENTION GROUP (Exercise + Low Lipid Diet): Constant aerobic exercise consisting of running for 30 min at 70–85 % HRmax, with 15 min stretching exercises to warm-up and 15 min to cool-down (total of 1 h).

NON-EXERCISING CONTROL GROUP (Low Lipid DIet Only): 45 min soft stretching and relaxation routines, three times a week also supervised by one of the investigators, without significant elevation of HR.

3X per week for 12 weeks

NR

Supervised

Tiozzo (2011) [26]^a

Randomized exercise and control groups [2 groups]

CONSTANT AEROBIC + PRE versus NON-EXERCISING CONTROL

37

39 %

100 %

23

14/37 (38 %)

EXERCISE (AEROBIC + PRE) INTERVENTION GROUP: Moderate Intensity

Aerobic Exercise: Week 1 and 2: These 2 weeks were a phase-in period allowing participants to acclimate gradually to the exercise protocol. This consisted of 3 endurance sessions, 5 min warm up and cool down periods and 10–15 min of aerobic exercise utilizing a stationary treadmill or bike ergometer at an intensity of 60 % maximal heart rate. Progression of Aerobic Intensity: After the initial 60 % of aerobic training intensity and 60 % of 1RM resistance training intensity during the phase in period, intensity was gradually increased to 65 % of HRmax and 65 % of 1RM in Step 1, to 70 % in Step 2 and to 75 % in Step 3.

PRE: All endurance sessions were followed immediately by core consisting of 8 two to three sets of 15 to 20 repetitions, and one set of 12 repetitions for ten exercises performed on stacked weight machines. The initial level for the resistance exercises was set at 60 % of one repetition maximum (1RM). Progression of PRE Intensity: In addition, Step 1 consisted of high repetitions (12), followed by lower repetitions in Step 2 and Step 3 (10 and 8 repetitions, respectively). Furthermore, similar to the phase-in period, other phases also allocated the same amount of time to each component (aerobic versus resistance) of the exercise program.

NON-EXERCISING CONTROL GROUP: Participants were asked not to participate in any form of exercise.

3X per week for 12 weeks

Wellness medical centre

Supervised

Yarasheski (2011)^a [25]

Randomized exercise + pioglitazone versus pioglitazone only [2 groups]

CONSTANT AEROBIC + PRE + PIOGLITAZONE versus PIOGLITAZONE ONLY

44 (with insulin resistance, impaired glucose intolerance and central adiposity)

13 %

100 %

39

5/44 (11 %)

EXERCISE (AEROBIC + PRE) PLUS PIOGLITAZONE GROUP:

Aerobic Exercise: Stationary cycling, treadmill walk/jogging, stair stepper climbing, or elliptical training device. Target HR range during aerobic exercise was 50–85 % HR reserve (moderate to high intensity). During exercise, HR and time at the target HR were monitored. Signaled an alarm if target HR was not maintained. HR and time data were stored to verify adherence and response to the exercise. Trainer progressively increased the exercise intensity as the participants adapted.

PRE: 4 upper and 3 lower body exercises following the aerobic session. Baseline 1 repetition maximum was measured during the 1st 3–4 exercise sessions on each of the machines. Initially PRE consisted of 1–2 sets of each exercise while lifting a weight that caused muscle fatigue/failure after 8 repetitions. The trainer monitored the participant’s exercise response daily and when the participant comfortably lifted the weight for 12 reps on any exercise, the weight (intensity) was increased by an amount 10 % that caused the muscle group to fatigue/fail after 8 reps. This progressive 8–12 repetition cycle was repeated for each exercise over the 4 month period.

PIOGLITAZONE ONLY GROUP: Participants consumed a standard weight diet that contained adequate amounts of energy and macronutrients.

90-120 min session; 3X per week for 16 weeks

Indoor exercise facility

Supervised