Abstract
[Purpose]
This study compared the effects of moderate-intensity exercise (MIE), vigorous-intensity exercise (VIE), and combined moderate- and vigorous-intensity exercise (CIE) on cardiorespiratory fitness, anthropometric variables, cardiometabolic risk factors, and adipokine levels in overweight and obese postmenopausal women under matched exercise energy expenditure conditions.
[Methods]
Seventy-four postmenopausal women completed the study: MIE (n = 19), CIE (n = 20), VIE (n = 17), and control (CON; n = 18). Participants in the exercise groups performed supervised aerobic training for 12 weeks with matched energy expenditure (approximately 1,700 kcal/week). Outcomes were assessed pre- and post-intervention using two-way repeated-measures ANOVA.
[Results]
VO2peak increased significantly in all exercise groups compared to CON, with no significant differences between the groups. Body weight and body mass index (BMI) decreased significantly in all exercise groups compared with those in the CON group. Decreases in waist circumference were greater in the CIE and VIE groups than in the CON group, whereas changes in body fat percentage were less consistent. Fasting insulin and Framingham Risk Score-related indices improved in some groups, whereas blood pressure, triglyceride, and glucose levels showed no consistent between-group differences. Leptin levels decreased significantly in all the exercise groups, with greater reductions observed in the CIE and VIE groups than in the CON group. Only adiponectin demonstrated a significant change over time.
[Conclusion]
Energy-matched aerobic exercise improved cardiorespiratory fitness and several anthropometric outcomes regardless of intensity. However, exercise programs incorporating vigorous-intensity components yielded greater reductions in waist circumference, indicating additional benefits for abdominal obesity-related outcomes.
Keywords: postmenopausal women, aerobic exercise, adipokines, overweight, cardiometabolic health
INTRODUCTION
Regular aerobic exercise is widely recommended as a primary strategy for improving body composition and reducing cardiometabolic risk in overweight and obese individuals. Current physical activity guidelines recommend that adults engage in at least 150–300 min of moderate-intensity aerobic exercise, or 75–150 min per week of vigorous-intensity aerobic exercise, or an equivalent combination of both per week to maintain and promote health [1,2]. However, individuals with obesity may require higher exercise volumes to achieve clinically meaningful reductions in body weight and adiposity [3-5]. Extensive evidence indicates that aerobic exercise improves body composition and several cardiometabolic risk factors in overweight and obese adults [6-7].
Although aerobic exercise markedly improves cardiometabolic health, the extent to which exercise intensity influences physiological adaptations remains unclear. Some studies have reported that vigorous-intensity exercise (VIE) yields greater improvements in cardiorespiratory fitness (CRF) and larger reductions in adiposity than moderate-intensity exercise (MIE) [8]. Conversely, other studies have reported comparable improvements in body composition and metabolic health when the total exercise energy expenditure was similar between moderate- and vigorous-intensity interventions [9,10]. These discrepancies may be partly attributable to the differences in total exercise volume across studies, making it difficult to elucidate the independent effects of exercise intensity. Moreover, the effects of combining moderate- and vigorous-intensity exercises within a single weekly regimen remain underexplored, particularly when energy expenditure is standardized across intervention groups.
Beyond its effects on body composition, aerobic exercise may enhance cardiometabolic health by modulating adipose tissue-derived hormones known as adipokines. Adipokines, such as leptin and adiponectin, play key roles in regulating energy balance, insulin sensitivity, and inflammatory processes associated with obesity [11,12]. Leptin, primarily secreted by adipocytes, is positively associated with the regulation of adiposity and energy balance, whereas adiponectin enhances insulin sensitivity and exerts anti-inflammatory effects. Exercise interventions reduce circulating leptin levels and improve adipokine profiles, suggesting a potential mechanism through which exercise improves metabolic health. However, the adiponectin responses to exercise training remain inconsistent across studies, particularly in different populations and training protocols [13-16]. However, the extent to which exercise intensity influences these adipokine responses remains unclear.
Postmenopausal women are particularly susceptible to developing obesity-related cardiometabolic diseases. Menopause-associated hormonal changes are linked with increased visceral adiposity, reduced CRF, and unfavorable cardiometabolic profiles in midlife and postmenopausal women [17-19]. Accordingly, identifying effective exercise strategies to improve cardiometabolic health in overweight or obese postmenopausal women is of considerable clinical relevance. Although aerobic exercise has been demonstrated to improve cardiometabolic health in this population, limited research has directly compared the effects of different exercise intensity strategies, while controlling for total exercise energy expenditure [20-22].
Therefore, this present study aimed to compare the effects of three aerobic exercise intensity strategies, namely MIE, VIE, and combined moderate- and vigorous-intensity exercise (CIE), on CRF, body composition, adipokines, and cardiometabolic risk markers in postmenopausal women with overweight or obesity.
METHODS
Participants
A total of 111 women enrolled in the National Fitness Award (NFA) project were screened for eligibility. An a priori power analysis conducted using G*Power 3.1 indicated that a minimum total sample size of 48 participants (12 per group) was required to detect a medium effect size (f = 0.25) with 80% power at α = 0.05 for a two-way repeated-measures analysis of variance (ANOVA) with four groups and two time points. To account for potential dropouts, 20 participants per group were recruited, and 80 participants were randomized. After excluding the participants who did not achieve the required compliance during the intervention, 74 postmenopausal women were included in the final analysis. The baseline characteristics of the study participants are shown in Table 1. Post-menopausal status was defined as the absence of menstruation for at least 12 consecutive months. The NFA is a voluntary community-based national fitness program that provides individualized fitness assessments and exercise prescriptions to promote physical activity throughout the lifespan of Koreans.
Table 1.
Baseline characteristics of the participants
| Variable | MIE (n = 19) | CIE (n = 20) | VIE (n = 17) | CON (n = 18) | p |
|---|---|---|---|---|---|
| Age (years) | 57.37 ± 2.56 | 54.45 ± 3.99 | 54.59 ± 4.02 | 54.50 ± 4.41 | 0.054 |
| Height (cm) | 155.81 ± 5.29 | 157.76 ± 4.71 | 156.45 ± 4.52 | 156.00 ± 4.23 | 0.567 |
| Weight (kg) | 66.39 ± 9.80 | 67.22 ± 9.57 | 65.35 ± 8.26 | 63.08 ± 7.90 | 0.528 |
| BMI (kg/m2) | 27.36 ± 3.80 | 26.97 ± 3.20 | 26.64 ± 2.64 | 25.92 ± 3.17 | 0.587 |
| WC (cm) | 90.89 ± 10.53 | 91.48 ± 8.07 | 88.74 ± 5.81 | 88.71 ± 6.42 | 0.615 |
| BF (%) | 37.11 ± 7.49 | 34.73 ± 4.75 | 35.23 ± 4.89 | 33.70 ± 5.36 | 0.333 |
| VO2peak (mL/kg/min) | 22.73 ± 3.08 | 22.40 ± 4.24 | 23.53 ± 4.47 | 22.73 ± 3.96 | 0.796 |
Values are presented as the mean ± SD. MIE, moderate-intensity exercise; CIE, combined moderate- and vigorous-intensity exercise; VIE, vigorous-intensity exercise; CON, control; BMI, body mass index; WC, waist circumference; BF, body fat percentage; VO2peak, peak oxygen uptake.
Participants were excluded at screening if they had a body mass index (BMI) < 23 kg/m2, participated in regular structured exercise (≥ 3 sessions per week) within the preceding 3 months, or had a history of serious cardiovascular, metabolic, or pulmonary disease. Additionally, participants who did not attend ≥ 80% of the prescribed exercise sessions during the intervention period were excluded from the final analysis. In Korean adults, a BMI ≥ 23 kg/m2 is classified as overweight [23].
All participants were instructed to maintain their usual dietary habits and physical activity levels throughout the intervention period. Dietary intake was assessed using a 24-h dietary recall questionnaire at baseline and upon completion of the intervention.
Study Design
This study was conducted as a randomized controlled trial (RCT). Following baseline assessments, eligible participants were randomly allocated to one of the following four groups: MIE (n = 20), CIE (n = 20), VIE (n = 20), or a non-exercise control group (CON; n = 20). The participants in the three exercise groups completed a 12-week supervised aerobic exercise intervention with matched exercise energy expenditure. Participants assigned to the CON group were instructed to maintain their usual daily activities throughout the intervention period and offered the opportunity to participate in the NFA exercise program following study completion. CRF and cardiometabolic outcomes, including VO2peak, BMI, waist circumference (WC), body fat percentage (BF), blood pressure (BP), fasting glucose, insulin, triglycerides, leptin, adiponectin, and Framingham Risk Score (FRS), were evaluated before and after the intervention. A flow diagram illustrating participant recruitment, randomization, follow-up, and analysis is shown in Figure 1.
Figure 1. Participant flow diagram.
A total of 111 women were assessed for eligibility, among which 80 were randomized, and 74 were included in the final analysis. MIE, moderate-intensity exercise; CIE, combined moderate- and vigorous-intensity exercise; VIE, vigorous-intensity exercise; CON, control.
Anthropometric Measurements
Prior to the graded exercise test, body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively, with participants wearing light clothing and no shoes. BMI was calculated as body weight divided by height squared (kg/m2). WC was measured to the nearest 0.1 cm at the level of the umbilicus at the end of normal expiration while the participants were standing upright. BF was assessed using bioelectrical impedance analysis with a body composition analyzer (InBody 720; Biospace Co., Seoul, Korea). Resting BP was measured after 5 min of seated rest using a mercury sphygmomanometer. Participants were instructed to avoid caffeine intake and exercise for at least 30 min before measurement. The average of two BP measurements obtained on two separate days was used for analysis.
Exercise Testing
CRF was assessed using a maximal graded exercise test (GXT) with direct measurement of oxygen uptake (VO2) to individually prescribe exercise intensity. Participants were instructed to avoid strenuous physical activity and alcohol intake for 48 h prior to testing and to consume only a light meal at least 3 h before assessment. The GXT was performed in a temperature-controlled laboratory (21–23 °C) using a cycle ergometer (Monark Ergomedic 818E, Monark-Crescent AB, Varberg, Sweden). The pedaling cadence was maintained at 60 rpm, and the workload was increased by 15 W per minute until volitional exhaustion. Pulmonary ventilation, oxygen uptake, and carbon dioxide output were measured using a computerized metabolic gas analysis system (QMC, Quinton, Boston, MA, USA) in mixing chamber mode. VO2peak was defined as the highest 30-s average oxygen uptake value achieved during the test and was confirmed when at least two of the following criteria were met: (1) a plateau in VO2 despite increasing workload (≤ 2 mL/kg/min increase between consecutive stages), (2) a respiratory exchange ratio ≥ 1.10, (3) a heart rate within 10 beats/min of the age-predicted maximum (220 − age), or (4) a rating of perceived exertion (RPE) ≥ 17. For safety monitoring, the heart rate and RPE were recorded at each stage, and participants were continuously monitored using electrocardiography throughout the assessment.
Biochemical Analyses
Venous blood samples were collected after an overnight fast of at least 8 h. Glucose concentrations were measured from finger-prick blood samples using an automated enzymatic analyzer (Cholestech LDX, Cholestech, Hayward, CA, USA). Serum samples were isolated for the analysis of insulin, triglycerides, adiponectin, and leptin and stored at -70 °C until the assay. Serum insulin, adiponectin, and leptin levels were measured using multiplex bead-based assays (Millipore, Billerica, MA, USA), according to the manufacturer’s instructions. Serum triglyceride concentrations were measured using an enzymatic colorimetric assay. All analyses were performed in duplicate, and control samples were included in each assay batch. The FRS was calculated using the sex-specific algorithm developed by D’Agostino et al. [24]. This algorithm incorporates age, total cholesterol, HDL cholesterol, systolic blood pressure (SBP), antihypertensive medication use, smoking status, and diabetes status to estimate the 10-year general cardiovascular disease risk. Both the FRS total score and estimated 10-year risk probability (%) were calculated using this algorithm.
Exercise Intervention
Participants assigned to the three exercise groups completed a 12-week supervised aerobic exercise program. Weekly exercise frequency and intensity differed between the groups: the MIE group performed six sessions per week at 50% of VO2peak, with each aerobic session lasting approximately 60 min (total: ~360 min/week). The CIE group performed three sessions per week at 50% of VO2peak and two sessions per week at 70% of VO2peak, with each session lasting approximately 60 min (total: ~300 min/week). The VIE group performed four sessions per week at 70% of VO2peak, with each aerobic session lasting approximately 60 min (total: ~240 min/week). Each exercise session consisted of a 10-min warm-up, followed by the prescribed aerobic exercise, and ended with a 10-min cool-down. The exercise sessions were performed using a stationary cycle, treadmill, and elliptical machine. Exercise energy expenditure per session (EE) was estimated using the formula: EE (kcal) = metabolic equivalent (MET) × body weight (kg) × exercise duration (h). MET values of 3.3 and 8.0 were assigned to moderate- and vigorous-intensity exercises, respectively, based on the ACSM Compendium of Physical Activities [25]. To ensure an isocaloric condition across the groups, the aerobic exercise duration was individually adjusted for each participant on a weekly basis to achieve a target energy expenditure of approximately 1,700 kcal/week.
The exercise intensity was prescribed according to the maximal heart rate corresponding to the target percentage of VO2peak determined during the GXT. To ensure that participants exercised at the prescribed intensity, heart rate was continuously monitored throughout each session using a heart rate monitor (Polar RS400TM, Polar Electro, Kempele, Finland). Exercise intensity was gradually increased during the first 2 weeks of the intervention, and the workloads on the exercise equipment were individually adjusted based on the heart rate response of each participant. All exercise sessions were supervised by qualified exercise instructors, and attendance was recorded for each session. Participants who failed to attend at least 80% of the prescribed exercise sessions were excluded from the final analysis. Participants assigned to the CON group were instructed to maintain their usual daily activities and refrain from participating in any structured exercise program during the intervention period.
Statistical Analysis
Data are presented as the mean ± standard deviation (SD). Statistical analyses were performed using IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). Baseline characteristics were compared among the groups using one-way ANOVA. Intervention effects were evaluated using two-way repeated-measures ANOVA, with time (pre- and post-intervention) as the within-subject factor and group (MIE, CIE, VIE, and CON) as the between-subject factor. When significant main effects or interactions were observed, Bonferroni-adjusted post-hoc comparisons were performed. Effect sizes were reported as partial eta squared (ηp2). Statistical significance was set at p < 0.05.
RESULTS
Participant Characteristics and Exercise Compliance
Baseline characteristics were comparable across the groups. Exercise compliance was high and did not differ significantly across the three groups (MIE: 95.6%; CIE: 96.1%; and VIE: 96.6%; p = 0.841). As intended by the study design, the mean exercise intensity differed significantly among groups (MIE: 53.1% VO2peak, CIE: 63.5% VO2peak, and VIE: 72.6% VO2peak; p < 0.001). Notably, the actual mean weekly exercise energy expenditure achieved was comparable across groups (MIE: 1,719.8 ± 283.3 kcal; CIE: 1,718.2 ± 444.8 kcal; and VIE: 1,749.3 ± 362.3 kcal; p = 0.867), confirming successful implementation of the iso-caloric design.
VO2peak
Changes in VO2peak following the 12-week intervention are shown in Figure 2. Two-way repeated-measures ANOVA revealed a significant main effect of time (F(1, 70) = 58.41, p < 0.001, ηp2 = 0.455), a significant main effect of group (F(3, 70) = 3.67, p = 0.016, ηp2 = 0.136), and a significant time × group interaction (F(3, 70) = 8.81, p < 0.001, ηp2 = 0.274. Post hoc analysis indicated significant increases in VO2peak in the MIE, CIE, and VIE groups (all p < 0.05), but not in the CON group. Moreover, the increases in VO2peak were significantly greater in the MIE, CIE, and VIE groups than in the CON group (all p < 0.05), although no significant differences were observed among the three exercise groups.
Figure 2. Changes in VO2peak following the 12-week exercise intervention.
(a) Pre- and post-intervention VO2peak values across the intervention groups. Data are presented as mean ± SD. (b) Changes in VO2peak (ΔVO2peak) following the intervention. Box plots represent the median, interquartile range, and minimum–maximum values. *p < 0.05 vs. pre-intervention values within the same group. ap < 0.05 vs. CON for the change from pre- to post-intervention.
Anthropometric Variables
Changes in body weight, BMI, WC, and BF following the 12-week intervention are shown in Table 2. For body weight, two-way repeated-measures ANOVA revealed a significant main effect of time (F(1, 70) = 57.86, p < 0.001, ηp2 = 0.442), but no significant main effect of group (F(3, 70) = 0.25, p = 0.858, ηp2 = 0.011). A significant time × group interaction was observed (F(3, 70) = 10.83, p < 0.001, ηp2 = 0.317). Post hoc analysis indicated significant decreases in body weight in the MIE, CIE, and VIE groups (all p < 0.05), but not in the CON group. Furthermore, the reductions in body weight were significantly greater in all exercise groups than that in the CON group (all p < 0.05). However, no significant differences in body weight reduction were observed among the three exercise groups.
Table 2.
Changes in anthropometric variables following the 12-week exercise intervention
| Variable | Group | Pre-intervention | Post-intervention | Δ | Values | F | p |
|---|---|---|---|---|---|---|---|
| Weight (kg) | MIE | 66.39 ± 9.80 | 63.74 ± 9.64* | -2.66 ± 2.40a | Time | 57.86 | < 0.001 |
| CIE | 67.22 ± 9.57 | 63.42 ± 8.03* | -3.80 ± 2.72a | Group | 0.25 | 0.858 | |
| VIE | 65.35 ± 8.26 | 62.76 ± 7.39* | -2.59 ± 1.92a | Time × Group | 10.83 | < 0.001 | |
| CON | 63.08 ± 7.90 | 63.19 ± 7.79 | 0.11 ± 1.28 | ||||
| BMI (kg/m2) | MIE | 27.36 ± 3.80 | 26.27 ± 3.92* | -1.08 ± 1.14a | Time | 55.05 | < 0.001 |
| CIE | 26.97 ± 3.20 | 25.31 ± 2.53* | -1.66 ± 1.05a | Group | 0.30 | 0.823 | |
| VIE | 26.64 ± 2.64 | 25.47 ± 2.24* | -1.17 ± 0.88a | Time × Group | 10.17 | < 0.001 | |
| CON | 25.92 ± 3.17 | 25.97 ± 2.99 | 0.04 ± 0.75 | ||||
| WC (cm) | MIE | 90.89 ± 10.53 | 86.82 ± 10.18* | -4.07 ± 4.67 | Time | 83.43 | < 0.001 |
| CIE | 91.48 ± 8.07 | 85.58 ± 7.33* | -5.90 ± 3.91a | Group | 0.29 | 0.830 | |
| VIE | 88.74 ± 5.81 | 84.51 ± 5.48* | -4.22 ± 2.67a | Time × Group | 4.65 | 0.005 | |
| CON | 88.71 ± 6.42 | 87.07 ± 7.01 | -1.64 ± 2.04 | ||||
| BF (%) | MIE | 37.11 ± 7.49 | 34.07 ± 6.26* | -3.04 ± 4.42a | Time | 7.38 | 0.008 |
| CIE | 34.73 ± 4.75 | 33.43 ± 4.37 | -1.30 ± 3.11a | Group | 0.37 | 0.776 | |
| VIE | 35.23 ± 4.89 | 33.18 ± 3.92 | -2.05 ± 3.35a | Time × Group | 5.76 | < 0.001 | |
| CON | 33.70 ± 5.36 | 35.27 ± 3.55 | 1.58 ± 3.04 |
Values are presented as the mean ± SD.
p < 0.05 vs. pre-intervention values within the same group.
p < 0.05 vs. CON for the change from pre-intervention to postintervention.
MIE, moderate-intensity exercise; CIE, combined moderate- and vigorous-intensity exercise; VIE, vigorous-intensity exercise; CON, control; BMI, body mass index; WC, waist circumference; BF, body fat percentage.
For BMI, a significant main effect of time (F(1, 70) = 55.05, p < 0.001, ηp2 = 0.430) and a significant time × group interaction (F(3, 70) = 10.17, p < 0.001, ηp2 = 0.303) were observed. However, the main effect of group was not significant (F(3, 70) = 0.30, p = 0.823, ηp2 = 0.013. Post hoc analysis indicated significant decreases in BMI in the MIE, CIE, and VIE groups (all p < 0.05), whereas no significant changes were observed in the CON group. BMI reduction was significantly greater in all exercise groups compared with the CON group (all p < 0.05); however, no significant differences in BMI reduction were observed among the three exercise groups.
For WC, significant effects of time (F(1, 70) = 83.43, p < 0.001, ηp2 = 0.533) and a significant time × group interaction (F(3, 70) = 4.65, p = 0.005, ηp2 = 0.166) were observed. However, the main effect of group was not significant (F(3, 70) = 0.29, p = 0.830, ηp2 = 0.012). Post hoc analysis revealed significant reductions in WC in the MIE, CIE, and VIE groups (all p < 0.05). Moreover, the reductions in WC were significantly greater in the CIE and VIE groups than in the CON group (all p < 0.05); however, no significant differences in WC reduction were observed among the three exercise groups.
For BF, significant effects of time (F(1, 70) = 7.38, p = 0.008, ηp2 = 0.092) and a significant time × group interaction (F(3, 70) = 5.76, p = 0.001, ηp2 = 0.198) were observed. However, the main effect of group was not significant (F(3, 70) = 0.37, p = 0.776, ηp2 = 0.016). Post hoc analysis revealed a significant decrease in BF only in the MIE group (p < 0.05). Notably, the changes in BF were significantly greater in all exercise groups than in the CON group (all p < 0.05); however, no significant differences in BF change were observed among the three exercise groups.
Cardiometabolic Risk Factors
Changes in cardiometabolic risk factors following the intervention are presented in Table 3. For SBP, two-way repeated-measures ANOVA revealed no significant main effects of time (F(1, 70) = 0.52, p = 0.474, ηp2 = 0.007), or group (F(3, 70) = 1.97, p = 0.127, ηp2 = 0.078); however, a significant time × group interaction was observed (F(3, 70) = 3.49, p = 0.020, ηp2 = 0.130). Although post-hoc analysis indicated reductions in SBP in the MIE and CIE groups, no significant between-group differences were observed following Bonferroni adjustment.
Table 3.
Changes in cardiometabolic risk factors following the 12-week exercise intervention
| Variable | Group | Pre-intervention | Post-intervention | Δ | Value | F | P |
|---|---|---|---|---|---|---|---|
| SBP (mmHg) | MIE | 125.89 ± 12.22 | 122.53 ± 11.36 | -3.37 ± 7.40 | Time | 0.52 | 0.474 |
| CIE | 126.55 ± 11.73 | 123.63 ± 11.62 | -2.93 ± 5.69 | Group | 1.97 | 0.127 | |
| VIE | 116.71 ± 9.43 | 120.53 ± 7.76 | 3.82 ± 7.16 | Time × Group | 3.49 | 0.020 | |
| CON | 119.17 ± 10.51 | 119.61 ± 10.40 | 0.44 ± 9.79 | ||||
| DBP (mmHg) | MIE | 78.71 ± 7.64 | 81.58 ± 7.40 | 2.87 ± 5.03 | Time | 0.91 | 0.344 |
| CIE | 80.85 ± 7.40 | 79.18 ± 8.86 | -1.68 ± 4.88 | Group | 2.68 | 0.054 | |
| VIE | 75.29 ± 5.76 | 77.00 ± 4.92 | 1.71 ± 5.38 | Time × Group | 2.98 | 0.037 | |
| CON | 76.06 ± 4.32 | 75.72 ± 5.11 | -0.33 ± 5.38 | ||||
| Triglycerides (mg/dL) | MIE | 100.58 ± 48.37 | 122.58 ± 71.16 | 22.00 ± 55.84 | Time | 0.01 | 0.949 |
| CIE | 110.10 ± 59.27 | 112.35 ± 43.04 | 2.25 ± 48.68 | Group | 0.43 | 0.735 | |
| VIE | 146.06 ± 98.20 | 106.59 ± 41.39 | -39.47 ± 81.17 | Time × Group | 3.87 | 0.013 | |
| CON | 116.61 ± 32.86 | 130.06 ± 56.04 | 13.44 ± 41.11 | ||||
| Glucose (mg/dL) | MIE | 106.79 ± 7.89 | 103.63 ± 7.97 | -3.16 ± 7.48 | Time | 5.50 | 0.022 |
| CIE | 103.90 ± 10.98 | 101.20 ± 10.32 | -2.70 ± 7.51 | Group | 0.42 | 0.742 | |
| VIE | 104.00 ± 13.26 | 101.59 ± 10.24 | -2.41 ± 11.06 | Time × Group | 0.04 | 0.988 | |
| CON | 107.06 ± 16.73 | 105.00 ± 19.17 | -2.06 ± 12.29 | ||||
| Insulin (mU/L) | MIE | 145.33 ± 61.35 | 112.16 ± 60.75* | -42.44 ± 46.34 | Time | 34.40 | < 0.001 |
| CIE | 132.50 ± 80.25 | 90.21 ± 45.32* | -41.39 ± 62.27 | Group | 1.31 | 0.278 | |
| VIE | 153.63 ± 93.66 | 105.81 ± 50.33 | -47.81 ± 84.50 | Time × Group | 0.12 | 0.946 | |
| CON | 114.06 ± 37.61 | 78.47 ± 28.52* | -34.87 ± 30.69 | ||||
| FRS total score | MIE | 7.47 ± 3.49 | 5.89 ± 3.71* | -1.58 ± 2.17 | Time | 8.50 | 0.005 |
| CIE | 7.85 ± 4.00 | 6.15 ± 3.99* | -1.70 ± 2.39 | Group | 0.44 | 0.727 | |
| VIE | 5.88 ± 3.72 | 5.65 ± 2.96 | -0.24 ± 2.39 | Time × Group | 1.64 | 0.187 | |
| CON | 6.72 ± 3.49 | 6.56 ± 3.70 | -0.17 ± 3.93 | ||||
| FRS risk probability (%) | MIE | 7.37 ± 3.30 | 5.68 ± 3.54* | -1.68 ± 1.97 | Time | 10.77 | 0.002 |
| CIE | 8.00 ± 4.26 | 6.00 ± 3.54* | -2.05 ± 2.91 | Group | 0.68 | 0.565 | |
| VIE | 5.82 ± 3.63 | 5.24 ± 1.92 | -0.59 ± 2.60 | Time × Group | 2.08 | 0.110 | |
| CON | 6.39 ± 3.33 | 6.39 ± 3.57 | 0.00 ± 3.60 |
Values are presented as the mean ± SD.
p < 0.05 vs. pre-intervention values within the same group.
MIE, moderate-intensity exercise; CIE, combined moderate- and vigorous-intensity exercise; VIE, vigorous-intensity exercise; CON, control; SBP, systolic blood pressure; DBP, diastolic blood pressure; FRS, Framingham Risk Score.
For diastolic blood pressure (DBP), no significant main effects of time (F(1, 70) = 0.91, p = 0.344, ηp2 = 0.013) or group (F(3, 70) = 2.68, p = 0.054, ηp2 = 0.103) were identified, although the time × group interaction was significant (F(3, 70) = 2.98, p = 0.037, ηp2 = 0.113). Furthermore, post hoc analysis revealed no significant within-group changes after adjustment, and no significant between-group differences in the change in DBP were identified.
For triglycerides, no significant main effects of time (F(1, 70) = 0.01, p = 0.949, ηp2 < 0.001) or group (F(3, 70) = 0.43, p = 0.735, ηp2 = 0.018) were observed; however, a significant time × group interaction was observed (F(3, 70) = 3.87, p = 0.013, ηp2 = 0.142). Post-hoc analysis indicated no significant within-group changes after adjustment, and no significant between-group differences in the change in triglycerides were observed.
Glucose exhibited a significant main effect of time (F(1, 70) = 5.50, p = 0.022, ηp2 = 0.073); however, no significant main effect of group (F(3, 70) = 0.42, p = 0.742, ηp2 = 0.018) or time × group interaction (F(3, 70) = 0.04, p = 0.988, ηp2 = 0.002) were observed. Meanwhile, for insulin, a significant main effect of time was observed (F(1, 70) = 34.40, p < 0.001, ηp2 = 0.330), whereas no significant main effect of group (F(3, 70) = 1.31, p = 0.278, ηp2 = 0.053) or time × group interaction (F(3, 70) = 0.12, p = 0.946, ηp2 = 0.005) was observed.
For the FRS total score, a significant main effect of time was observed (F(1, 70) = 8.50, p = 0.005, ηp2 = 0.108) with no significant main effect of group (F(3, 70) = 0.44, p = 0.727, ηp2 = 0.018) or time × group interaction (F(3, 70) = 1.64, p = 0.187, ηp2 = 0.066). Similarly, FRS risk probability exhibited a significant main effect of time (F(1, 70) = 10.77, p = 0.002, ηp2 = 0.133); however, no significant main effect of group (F(3, 70) = 0.68, p = 0.565, ηp2 = 0.028) or time × group interaction (F(3, 70) = 2.08, p = 0.110, ηp2 = 0.082) was observed.
Adipokines
Changes in leptin and adiponectin levels following the 12-week intervention are shown in Figure 3. For leptin, two-way repeated-measures ANOVA revealed significant main effects of time (F(1, 64) = 30.90, p < 0.001, ηp2 = 0.326) and a significant time × group interaction (F(3, 64) = 4.22, p = 0.009, ηp2 = 0.165), whereas the main effect of group was not significant (F(3, 64) = 0.77, p = 0.514, ηp2 = 0.035). Post hoc analysis revealed significant decreases in leptin levels in the MIE, CIE, and VIE groups (all p < 0.05), but not in the CON group. Moreover, the reductions in leptin levels were significantly greater in the CIE and VIE groups than in the CON group (both p < 0.05, Bonferroni-adjusted). However, no significant differences were observed among the three exercise groups. To determine whether decreases in leptin were associated with changes in adiposity, Pearson’s correlation analyses were conducted between changes in leptin levels and anthropometric variables across all participants. Notably, changes in leptin levels were significantly correlated with changes in body weight (r = 0.500, p < 0.001) and BMI (r = 0.424, p < 0.001), but not with changes in WC (r = 0.157, p = 0.192) or BF percentage (r = 0.083, p = 0.496).
Figure 3. Changes in adipokine levels following the 12-week intervention.
(a) Pre- and post-intervention leptin concentrations in each group. (b) Pre- and post-intervention adiponectin concentrations in each group. Data are presented as mean ± SD. *p < 0.05 vs. pre-intervention values within the same group.
For adiponectin, a significant main effect of time was observed (F(1, 65) = 10.47, p = 0.002, ηp2 = 0.139). However, the main effects of group (F(3, 65) = 0.11, p = 0.953, ηp2 = 0.005) and the time × group interaction (F(3, 65) = 0.12, p = 0.950, ηp2 = 0.006) were not significant. Overall, these findings indicate an overall temporal change in adiponectin levels across participants following intervention; however, no significant within-group changes or between-group differences were observed.
DISCUSSION
To our knowledge, this study is among the first to compare MIE, VIE, and CIE while matching the total exercise energy expenditure (isocaloric conditions; approximately 1,700 kcal per week) in overweight or obese postmenopausal women. The primary findings revealed that all three exercise interventions significantly improved VO2peak and reduced body weight and BMI, whereas changes in WC, cardiometabolic risk factors, and adipokines were more varied. Notably, reductions in WC and leptin levels were more pronounced in the CIE and VIE groups than in the control group.
A key finding of this present study was that VO2peak improved significantly in all exercise groups within 12 weeks, with no significant differences among the three exercise intensity conditions. This suggests that when the total exercise energy expenditure is matched, the overall exercise dose may be as important as the distribution of exercise intensity for improving CRF in postmenopausal women. These findings align with those by Ruiz-Ríos and Maldonado-Martin [20], who reported that physical activity interventions generally improve CRF in postmenopausal women, although the independent effects of exercise intensity remain difficult to elucidate across studies. Similarly, Lang et al. [19] and Weeldreyer et al. [26] demonstrated that higher CRF levels are strongly associated with lower all-cause and cardiovascular mortality, highlighting the clinical importance of improving VO2peak regardless of the specific exercise intensity used.
The anthropometric findings of this study further support the beneficial role of aerobic exercise in this population. Body weight and BMI decreased in all the exercise groups, whereas WC exhibited more pronounced reductions in the CIE and VIE groups. These findings suggest that general body mass-related outcomes may be primarily influenced by the total exercise dose, whereas central adiposity may be more responsive to the inclusion of VIE. This interpretation aligns with recent evidence indicating that aerobic exercise is associated with clinically meaningful reductions in body weight, WC, and BF, particularly when adequate weekly exercise volume is achieved [27,28]. Recent reviews have further suggested that resistance or combined exercise programs may complement aerobic training to improve body composition, metabolic risk, physical fitness, and bone-related health in postmenopausal women [29-32]. Taken together, our findings suggest that combined or vigorous-intensity exercise may yield additional benefits for improving abdominal obesity-related outcomes, even when total exercise energy expenditure is matched.
In contrast to the marked improvements in VO2peak and anthropometric outcomes, the cardiometabolic findings were less consistent. Notably, although significant time × group interactions were observed for SBP, DBP, and triglycerides, these effects did not translate to consistent between-group differences after post-hoc adjustment. Meanwhile, glucose levels demonstrated only a main effect of time, with no significant group differences. Notably, insulin levels decreased significantly over time; however, the absence of a significant time × group interaction together with significant reductions observed in the CON group suggests that this change was not attributable to the exercise intervention per se. Instead, it may reflect regression to the mean or the influence of other non-exercise-related factors. Huynh et al. [9] reported that aerobic exercise may improve cardiometabolic health in postmenopausal women but also emphasized that the effects on individual biomarkers, including triglycerides and glucose, are variable across studies. Similar inconsistencies have been reported in recent reviews that examined arterial stiffness, blood pressure, lipid profiles, and related cardiometabolic outcomes in postmenopausal women [22,33]. Therefore, these present findings suggest that longer intervention duration, larger sample sizes, or tighter control of diet and habitual physical activity are needed to elucidate clearer between-group differences for metabolic biomarkers.
Among the adipokines, leptin exhibited the most pronounced exercise-associated response. Leptin levels decreased significantly in all the exercise groups, and the reductions were greater in the CIE and VIE groups than in the control group. Given that leptin is primarily secreted by adipocytes and is positively associated with adiposity, greater reductions in abdominal adiposity in the CIE and VIE groups may have contributed to the more favorable leptin response observed in these groups [13,16]. Moreover, correlation analyses revealed that changes in leptin levels were significantly associated with changes in body weight and BMI, suggesting that reductions in leptin were at least partially secondary to overall reductions in body mass, rather than representing an independent effect of exercise intensity. Conversely, adiponectin exhibited an overall temporal trend, but no significant within-group or between-group differences were observed. This finding is consistent with previous studies suggesting that adiponectin responses to exercise training are highly variable and may require greater reductions in adiposity or longer intervention durations to manifest [16,34]. These inconsistent findings may also reflect menopause-related changes in adipocyte metabolism and chronic inflammation, which can alter the metabolic response to exercise [35,36].
The results of this study have several practical implications. Notably, no single exercise intensity distribution was clearly superior for all outcomes when total exercise energy expenditure was matched. This finding supports the use of individualized aerobic exercise prescriptions in postmenopausal women based on exercise tolerance, preference, and long-term adherence. Nevertheless, this study has several limitations that should also be acknowledged. Firstly, the sample size in each group was modest. Secondly, some biochemical analyses included missing data. Thirdly, dietary intake and habitual physical activity outside the supervised sessions were not rigidly controlled. Lastly, the 12-week intervention durations may have been insufficient to elicit substantial changes in all metabolic and endocrine outcomes. Despite these limitations, the present study is strengthened by its randomized controlled design, the use of fully supervised exercise sessions, high compliance rates, and direct comparison of three distinct energy-matched aerobic exercise programs. In conclusion, all energy-matched aerobic exercise programs improved CRF and general anthropometric outcomes, along with reducing leptin levels. Crucially, the inclusion of VIE strategies may yield additional benefits for WC. Conversely, cardiometabolic biomarkers exhibited variable responses across the groups, indicating that further studies with longer intervention durations or larger sample sizes are warranted.
Footnotes
ACKNOWLEDGMENT
Funding: This study was supported by a research grant from the Korea Sports Promotion Foundation (MCST-1009).
The authors declare no conflict of interest.
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