Effects of Caloric Restriction Associated with Low-Impact Aerobics and Strength Training Exercises on Body Composition and Cardiovascular Diseases Risk Factors among Obese Students with Metabolic Syndrome

1. Enhanced Lifestyle Counseling Each participant was offered one education session/month during 4 months with 30-60 min in length each one and conducted by lifestyle coaches, who were trained and certified in intervention before the experiment began. Participants were encouraged to produce a weight loss between 0.5 and 1%/week of the own weight by reducing calories intake and increasing energy expenditure. Coaches act to reinforce motivation and sustain the weight reduction programs by resolving problems derived from self-monitoring, behavioural modifications, controlling stimulus, physical training, and appearance. 2. Dietary Protocol A dietician established a balanced and personalized dietary restriction program for each subject based on an initial dietary behavior assessment (the amounts of food and fluid consumed by each subject for a week and the relevant timestamps were recorded). Each individual’s diet was designed according to their dietary habits and other selected foods with low glycemic indices, which were mainly fruits, vegetables, and whole grains. Fast foods, sugar-sweetened drinks, energy drinks, French fries, potato chips, cake, donuts, and sweets were to be avoided. Subjects' targeted daily caloric intake deficit was approximately 500 kcal/day, and diets were composed of approximately 15-20% proteins and 25-30% lipids, with carbohydrates representing the remainder of the caloric intake. A software for food coaching was used to calculate participants' food intake and composition (S.C.D.A. Nutrisoft, Le Hallier 37390 Cerelles, France). 3. Physical activity The program includes three sessions per week over a 12-week period of Low-impact aerobics (LIA), and resistance exercises performed on machines or with free weights. Each session involved a 5- to 10-minute warm up including walking and stretching exercises, an exercise session, and a 5- to 10-minute cooldown involving breathing and stretching exercises. The exercise session was divided into two sections (section I: LIA; section II: resistance exercises). The LIA section lasted between 30 and 40 min and involved rhythmic, non-jumping exercises, to elevate the heart rate and improve circulation without jarring knees or worsening back pain: walking on treadmill and/or moving on elliptical and/or a workout regimen combining taekwondo and boxing (TAE BO). The initial intensity was set at 65% of the theoretical heart rate max (200 - age in years), with monthly incrementation of 5%. The resistance training section involved a circuit of selected six exercises performed on machines or with free weights involving most muscle segments and groups. Each exercise was performed for three sets of 8-12 repetitions each with a 1-min rest between sets and a 3-min rest between exercises. The initial training load was set at 60% 1RM and was increased every four weeks by 5% for the upper limb exercises and 10% for the lower limb exercises. The 1-RM values were predicted from the 4-6-RM tests performed at the first workout of the first week. Professional trainers supervised all training sessions, and a polarity analyzer (Polar Electro Oy, Finland) was used to control heart rates throughout the session.