WOLF study: Weight loss with high intensity Functional exercise for men with Obstructive sLeep apnoea.

High intensity functional exercise intervention program for weight loss in overweight and obese patients with obstructive sleep apnoea not treated with continuous positive airway pressure (CPAP). This is a two arm pilot randomised controlled trial. All participants (n=30) will undergo a commercially available very low energy diet (VLED). Participants will be randomised to either participating in the exercise intervention (n=15) or diet alone (n=15). The exercise intervention is a 3 month face-to-face stepped program of increasing high intensity functional exercise at a commercially available exercise facility (F45 gyms). Participants will undertake a combination of high intensity (as measured by activity trackers with heart rate monitoring and the Borg RPE scale) resistance and aerobic-based group classes which last a duration of 45 minutes each. Exercise sessions involve functional motions including but not limited to kicking, punching, rowing, running, pulling, pushing, squatting, lifting, jumping, tossing and twisting. Sessions involve a rotating program of exercises completed at stations. Exercises are performed for approximately 30-45 seconds with a 15 second rest interval between stations. Classes are conducted by trained exercise professionals employed by the exercise company. The level of training of these exercise professionals range from a tertiary diploma through to a University degree. The class schedule is as follows: week 1-2: 2x resistance based classes per week weeks 3-6: 2x resistance based classes, 1x aerobic based class per week weeks 7-8: 2x resistance based classes, 2x aerobic based classes per week weeks 9-12: 2x resistance based classes, 3x aerobic based classes per week The exercise program will be adapted to meet the specific of each participant and appropriate adjustments will be made. Adherence to the exercise program will be assessed through reports from participants and by the data obtained through activity trackers provided to patients. The diet component consists of a 3 month period where participants replace meals with a commercially available very low energy diet product for example bars, soups or shakes from brands such as Tony Ferguson, OptiFast, OptiSlim, KickStart or Formulite. Participants will be provided with the VLED product and will be required to prepare each serving according to manufacturer’s instructions. Individual protein requirements and the number of replacements required for each participant will be determined by a trained physician, dietitian or exercise physiologist as per the participant’s adjusted body weight. Protein needs are 1gm/kg of Adjusted Body Weight. Adjusted body weight is calculated using the following: ((Actual Body Weight - Ideal Body Weight) x 0.5) + IBW = Adjusted Body Weight Actual Body Weight = Current Weight Ideal Body Weight = Weight at BMI 25 The diet schedule is typically as follows: weeks 1-8: 3 x meal replacement bars, soups or shakes daily weeks 9-10: 2 x meal replacement bars, soups or shakes daily and 1 x standard meal weeks 11-12: 1 x meal replacement bar, soup or shake daily and 2 x standard meals Participants are encouraged to purchase, prepare and consume an extra 2 cups of vegetables and a teaspoon of oil daily whilst completing the initial 8 weeks of the diet. Patients who reach their desired body weight prior to completion of the 8 week period will be assessed whether to progress to a maintenance meal plan earlier than the 12 week timepoint. 24 hour food recall assessments will determine the rate of compliance of participants.