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Many Americans gain weight during adulthood, increasing their risk for many illnesses, not to mention the need and want for a trimmer, slimmer, less fatty body. Therefore, most adults should not, and do not want to gain weight. (www.nalusda.gov/fnic/dga/dga95/weight.html) These are some of the reasons why many Americans become motivated to turn to aerobic exercise to slim down their bodies and to become healthier human beings. The easiest way for Americans to generalize weight loss is through aerobic exercise.
Not only is obesity associated with reduced life expectancy, it is now well recognized that increased body fat is associated with heart disease, stroke, hypertension, dyslipidemia, type 2 diabetes mellitus, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, as well as numerous types of cancer (such as endometrial, breast, prostate, and colon). (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
The incidence of obesity in the United States has increased progressively since 1960. In the United States and in Europe, the incidences of being overweight and obese have reached epidemic proportions. Furthermore, in the past decade, the percentage of overweight and obese individuals in the United States and in some countries in Europe has increased to over 50% of adults aged 20 years or older. Obesity is age- dependent, with most people increasing their fat stores as they become older. Aging is associated with a decline in physical activity that contributes to decreased exercise tolerance, decreased lean body mass, and an increased fat mass, with alterations in metabolism. Therefore, while aging, our population is becoming obese.
Data from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) indicate that two thirds of overweight persons trying to lose weight reported using physical activity as a strategy for weight loss, but only one fifth reported being active at the recommended levels. As many clinicians have often observed, weight reduction is difficult to achieve and even more difficult to maintain. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
The word aerobic literally means with air or oxygen. Aerobic exercise can be defined as using the same large muscle group, rhythmically, for anywhere from 15 to 20 minutes or longer while maintaining an accelerated heart rate. Aerobic activity should be thought of as something long in duration yet low in intensity. (http://k2.kirtland.cc.mi.us/~balbachl/aeroprin.htm)
As previously stated, aerobic exercise uses large muscle groups rhythmically and continuously and elevates the heart rate and breathing for a sustained period. Care and consideration should be used in selecting the types of aerobic exercise one wants to participate in. Depending on one’s goals, physical condition, and injury/ illness history, different types may prove to be preferential for one’s particular situation. However, in general, it is a good idea to alternate between and among several different types of aerobic exercises. Specifically, it is important to alternate forms of high impact exercises, such as running, dancing, playing tennis, racquetball, or squash, with low/ moderate impact aerobic exercises, such as walking, swimming, stair climbing, step classes, rowing, or cross- country skiing. (http://www.bodytrends.com)
The key goals of exercise are to improve oxygen delivery and metabolic processes, build strength and endurance, decrease body fat, and improve movement in joints and muscles and ultimately trim down one’s figure. Due to the many benefits, it is obvious why many Americans turn to aerobic exercise to help improve their physical and mental state of being. (http://content.health.msn.com/printing/dmk/dmk_article_40034.html)
Aerobic physical exercise involves respiratory and circulatory systems as well as the enzymatic machinery adaptations that facilitate the muscle to work more effectively. When adaptation to endurance exercise has taken place, the muscle enzymes are completely filled with oxygen and they are better equipped to work at a low intensity for a longer duration of time. Additionally, they are able to use free fatty acid (FFA) as the main substance being burned off. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
The answer to this question is simple, exercise targets fat. When one exercises, their body begins to burn fat and use it as fuel.
Many studies on aerobic exercise have shown that more physically active people are less likely to eat foods that contain a lot of fat, also known as densely caloric foods. This plays an important role in the struggle to lose weight because healthy eating habits and weight loss go hand in hand. Without one, the other cannot perform to its pinnacle. Individuals including physical activity, as well as healthy eating habits, as part of a weight loss strategy are also far more likely to keep in shape than those who rely on dieting alone.
Also, by participating in aerobic workouts, one’s metabolic rate becomes elevated during the workout, and remains elevated even after exercise. The more strenuous the exercise, the longer one’s metabolism continues to burn calories before returning to its resting level. This state of elevated metabolism can last for as little as a few minutes after light exercise to as long as several hours after prolonged or heavy exercise. (http://health.msn.com)
According to different studies, when exercising, one can expect an additional fat loss amounting to between 0.2 lbs (Utter et al., 1998) and 0.5 lbs (Miller et al., 1997), depending on the frequency and duration of the exercise. Although this might not seem like a great deal, it is important to remember that moderate aerobic exercise is a key factor in preventing weight regain following a restricted calorie diet. Physical training helps counteract the lenient environment that, often times, influences reduced- obese subjects to regain weight. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)A direct relationship between weight loss and aerobic exercise may not be obvious because while exercising, one is burning off fat, but picking up more muscle. This leads to only a small difference in actual weight, but a more obvious difference concerning body size and shape. This is when it is most important to remember to look in the mirror and not at a scale.
A one- year study of 102 overweight adults at Baylor College of Medicine in Houston found that just 42% of the “diet only” group maintained or continued losing weight at the end of the year. In a group that exercised as well as dieted, 65% maintained or continued to lose weight. But in the group that only exercised, and didn’t worry about dieting, a remarkable 78% maintained or continued to lose weight. Thus showing that weight loss is spurred on, or encouraged aerobic exercise. (http://content.health.msn.com/printing/article/1758.healthink-233.html)
There is an inverse relationship between the amount of daily physical activity and body weight. Exercise requires energy, and the two main sources of fuel for muscle contraction are carbohydrates and lipids. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Numerous factors associated with obesity, that is, gender, body fat mass, adipose tissue distribution, and number and size of adipose cells, contribute to the eventual response to exercise training. For instance, in response to a 20- week exercise training program, one study (Tremblay et al) reported that men, matched for body fat mass, with a high fat cell size, lost six times more body fat mass than men with small adipose cells. Worth mentioning, however, is the fact that women in this study with either high or low fat cell size did not lose body fat. Therefore, it seems that there might be a certain morphology (size + number of cells + distribution) that may explain, at least to a certain extent, the susceptibility to lose weight in response to an exercise program. This idea may help explain why men decrease body fat more efficiently with physical training than do women.
Another important clinical issue that should be kept in mind is that when exercise is considered in the management of obesity, the weight loss may be accompanied by an increase in appetite. Careful attention should be given to this adaptation that could easily compromise weight loss. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
An important issue is whether one needs to focus on exercise intensity in order to achieve metabolic improvements in obese individuals. Associated with diet therapy, is low- intensity training of 30% to 50% of maximum heart rate for a long duration (anywhere from an hour and a half to four hours) and high frequency has been proposed for losing body fat. This recommendation is based on the thought that the dominant fuel for energy during the first 20 minutes of exercise is glycogen; exercising more than 30 minutes will increase the usage of fat stores. But, as obese people have a lower physical ability (defined by the relation between oxygen uptake and external work), the most appropriate approach to prescribe exercise is to base work intensity on the oxygen cost relative to the maximum heart rate. This notion has clinical importance, since subjects with obesity usually get standard recommendations to lose weight by decreasing food intake and increasing physical activities. For instance, normal- weight subjects use about 35% of the maximum heart rate when walking at a self- selected, comfortable pace. This activity is generally considered a convenient and mild form of training. It is accessible to everyone and carries a low risk of injuries, which are increased by obesity because of the burden of extra weight on the joints. Joint considerations should, however, not limit physical activity, since exercise combined with diet leads to improvement in pain, disability, and performance in obese older adults with any joint problems.
However, obese individuals often find the exercise prescription difficult to follow, since they get extremely tired while walking at the recommended pace. Thus, even walking may represent a difficultly for obese individuals, since they can use, on average, as much as 56% maximum heart rate (some using between 64% to 98% maximum heart rate) to meet the demand of such an activity compared to only about 35% in normal- weight subjects. Therefore, long and brisk walks should not be regarded as low- intensity forms of training for obese people in general.
Obese individuals who enjoy walking and who can tolerate this form of physical activity without too many unpleasant side effects should certainly continue to do so. In general, however, recommendations should focus on training regimens, not generating pain over time, otherwise obedience will obviously be impaired. It is also important to keep in mind that various types of aerobic training (i.e. walking cycling, swimming) may have different impacts on weight loss. Notably, swimming has generated rather disappointing results regarding weight loss. It is also very important to inform the patients about the results to be expected from the recommended exercise regimen in order to avoid unrealistic expectations on weight loss. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Body composition is made up of approximately 70% water, and a combination of all other body parts, referred to as “lean body mass”. An individual’s body weight can be determined by adding one’s body fat with their lean body mass.
A study completed at Appalachian State University showed an effect on body composition over a 12- week period. The research team assigned a group of 91 obese women to one of four groups. Group one followed a restricted calorie diet (1,200 – 1,300 calories per day). Group two performed moderate aerobic exercise for 45 minutes, five days each week. A third group combined the exercise and the diet program. While, the fourth group acted as controls. The results showed that aerobic exercise, as opposed to sedimentary activity, increased fat loss. (www.thefactsaboutfitness.com/print/1jan2001_print.htm) This is not surprising when you consider how many calories are contained in a pound of fat. Each pound of fat contains the equivalent of approximately 3,555 calories (McArdle et al., 1991). Which would require a substantial amount of exercise in order to burn off.
Moderate intensity aerobic exercise may also reduce fat under the skin to a greater extent than diet alone. Fat in the body is stored in three main areas – under the skin, surrounding the internal organs, and between muscle cells. Fat stored under the skin (known as subcutaneous tissue) is one of the main reasons many people decide to lose weight. It is the fat one can pinch; around the waist, arms or hips. Japanese scientists have discovered that a moderate aerobic exercise program can reduce subcutaneous tissue to a greater extent than diet alone (Abe et al., 1997). In contrast, diets appear to have a greater effect on the fat that surrounds the internal organs (known as visceral fat). With dieting alone, one burns lean body mass, or muscle, and a little fat, explains Dr. Anthony Wilcox, an exercise physiologist and the chairman of the Department of Exercise and Sports Science at Oregon State University. “I don’t think the public is well aware of the difference between weight loss and fat loss. Fat loss while maintaining lean body mass is what they need to be concerned about. If two people weigh the same, the one with more fat will look heavier than the one carrying dense muscle” Dr. Wilcox says. (http://content.health.msn.com/printing/article/1758.healthink-233.html) A pound of fat, though it actually weighs less than muscle, simply takes up more space. Even if weight loss is minimal, obese individuals showing a good level of cardio respiratory fitness are at reduced risk for cardiovascular mortality (heart attacks) than lean but poorly fit subjects. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Also, exercise keeps one’s body from becoming flabby as they lose weight. “If one does not exercise while dieting, they will actually lose muscle and get flabbier” explains Carrie Trimmer, M.S., an exercise physiologist at Penn State Hershey Medical Center and a member of the American College of Sports Medicine. (www.thefactsaboutfitness.com/print/1jan2001_print.htm)
This question is a pertinent one that boggles most American’s minds. It perplexes us, and inspires us to become physically fit. The claim that moderate aerobic exercise will speed up fat loss is what leads to the countless number of treadmills, rowing machines and stair steppers that adorn most gyms and seem to be in constant high demand. The treadmill burns the most calories of standard aerobic machines. It may be particularly effective when used in short multiple bouts of time during the day. In fact, exercise sessions as short as ten minutes in duration that are completed frequently (about four times daily) may be the most successful program for overweight people. (http://content.health.msn.com) (www.well-connected.com)
A recent review of several hundred weight loss studies, conducted by Dr. Wayne Miller and colleagues at The George Washington University Medical Centre (Miller et al., 1997) examined 493 studies that had been carried out between 1969 and 1994. Miller and his associates wanted to determine whether the addition of aerobic exercise to a restricted calorie diet accelerated weight loss. Twenty- five years of weight loss research showed that diet and aerobic exercise provides only a very marginal benefit (in terms of weight loss) when compared to diet alone. However, scientists from George Washington University found that regular exercise helps to maintain higher levels of weekly fat loss 12 months after starting a diet (Miller et al., 1997).
As mentioned earlier, physical activity as part of a fat loss strategy also appears to encourage healthier eating patterns. Californian researchers have identified a direct relationship between physical activity and other weight loss practices (Johnson et al., 1998). They found that physical activity was associated with healthier eating habits, such as snacking on fruits and vegetables.
Even more importantly, exercise speeds up one’s metabolism. If one stays active, they burn more calories, which helps maintain or decrease weight. During exercise, an elite athlete’s metabolic rate can increase 20 times its normal rate. But even “normal” humans operate at 10 to 12 times their usual metabolism during a moderate workout, says Eric Poehlman, Ph. D., of the Health Science Center at the University of Maryland at Baltimore. Most importantly, exercise makes weight loss stick.
Numerous adaptive responses take place with physical training. These adaptations result in a more efficient system for oxygen transfer to muscle, which is now able to better utilize the unlimited lipid stores instead of the limited carbohydrate reserves available. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
All adults should set a long- term goal to accumulate at least 30 minutes or more of moderate- intensity physical activity on most, and preferably all days. Public health interventions promote walking as the exercise most likely to be successful. It is noteworthy that there is a clear dissociation between the adaptation of cardio respiratory fitness and the improvements in the metabolic risk profile that can be induced by endurance training programs. It appears that as long as the increase in energy expenditure is sufficient, low- intensity aerobic exercise is likely to generate beneficial metabolic effects that would be essentially similar to those produced by high- intensity exercise. Therefore, one should focus on the improvement of the metabolic profile rather than on weight loss alone. Realistic goals should be set by the patient, with a weight loss goal of approximately .5 to 1 pound per week. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Approximately one pound per week can be lost with no change in physical activity if calorie intake is reduced by only about 500 calories a day. Although aerobic exercise alone produces a modest weight reduction, generally 2% to 3%, increased physical activity is extremely important in sustaining the weight- reduced state. An intervention combining behavior therapy, a low- calorie diet, and increased physical activity is probably the most successful management approach for weight loss and weight maintenance. In overweight/ obese patients who have reached the proper state in which they are ready to lose the weight, this approach should be emphasized and sustained for a few months before considering altering strategies. Weight loss programs that result in a slow but steady weight reductions, such as one pound to two pounds per week, may be more effective long- term tan those that result in rapid weight losses. Indeed, behavioral strategies reinforcing changes in diet and physical activity can produce weight loss in the range of 10% over a period of 6 months in obese adults. Unfortunately, long- term follow- up results of patients undergoing behavior therapy show a return to baseline, or original, weight for the majority of subjects who did not continue behavior intervention. These negative results reinforce the importance of incorporating daily exercise in the lifestyle of overweight/ obese patients. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Gender differences have also been reported in the adaptation of adipose tissue metabolism to aerobic exercise training. Physical training helps counteract the permissive and affluent environment that predisposes reduced- obese subjects to regain weight. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Concern has arisen over the use of short- term weight loss as the sole, or even primary, indicator of successful outcome. This is partly because repeated loss and regain of weight may be more hazardous to health and well being than a high but stable weight. (Evaluation of modified cognitive- behavioral program for weight management. International Journal of Obesity Related Metabolic Disorders. 2000 Dec. p.1726- 37)
VI. Does aerobic exercise have any effect on non-obese, healthy individuals?
The health benefits of regular exercise are well established. However, results regarding the effect of exercise on adipose tissue are conflicting. Many studies have shown the effect of exercise and diet on the amount and distribution of adipose tissue, but the effect of exercise alone on different adipose tissue depots is less studied. Furthermore, many studies examine the effects of exercise on body composition have used overweight or obese subjects, given that they appear to be more likely to benefit from a change in physical activity. Less is known, however, regarding the effect of a moderate amount of aerobic exercise on body fat content in non- obese healthy women. (Preferential loss of visceral fat following aerobic exercise, measured by MRI p.769 – 76)
A number of techniques have been applied to the study of body fat content following exercise. Underwater weighing and anthropometrics are often used, although these indirect techniques can be used to measure total body fat, they cannot be used to assess regional fat depots such as visceral fat. Computer- assisted tomography (CT) allows the direct measurement of visceral fat, but owing to the radiation dose involved, only single slices tend to be acquired. Magnetic resonance imaging (MRI) provides an accurate measure of body fat content as well as a direct measure of visceral fat content. MRI has previously been applied to studies that have shown changes in regional and total body fat in obese women following a combination of energy restriction and exercise. (Preferential loss of visceral fat following aerobic exercise, measured by MRI p.769 – 76)
Here are the results of one study directed by a group of scientists from The Robert Steiner MR Unit, MRC Clinical Sciences Centre, Imperial College School of Medicine, and the Hammersmith Hospital, London, England. This study is entitled Preferential loss of visceral fat following aerobic exercise, measured by magnetic resonance imaging.
Abstract: Moderate aerobic exercise over a period of 6 months resulted in a preferential loss in visceral fat in non- obese healthy women, and this may help to explain some of the health benefits associated with regular and moderate physical activity. In this study, we used whole- body MRI together with biochemical and anthropometrics measurements to determine the influence of regular moderate exercise with no dietary intervention on adipose tissue distribution in non- obese sedentary healthy women.
Subjects and Methods: Seventeen non- obese, pre- menopausal healthy (previously non- exercising) female volunteers, ranging in age from 25 to 45 years of age, were studied before and after 6 months of three times per week aerobic exercise. Regular attendance at a specific gym was an essential prerequisite for participation in this study. A whole- body MRI measured regional and total body fat contents. Body fat content was also measured by bioelectric impedance and skin fold anthropometry. Exercise records were regularly obtained from all the volunteers to ensure compliance with the exercise regime. Dietary intake was also measured at the beginning and at the end of the study to ensure that volunteers were not restricting their energy intake.
Exercise testing. All participants were assessed for their physical fitness at the National Sports Medicine Institute of the United Kingdom (Exercise Physiology Laboratory) before starting and at regular intervals throughout the study.
Physiological assessment. Following informed consent, all subjects were assessed for cardio respiratory fitness at the beginning of the study. The measurements on each visit to the test facility included resting lung function and the maximal rate of oxygen consumption.
Exercise. (i) Prescription. The results of the baseline cardio respiratory test were used to ensure that all subjects performed the same level of exercise. All participants were requested to perform three exercise sessions per week for a minimum of 30 minutes duration each time at a intensity corresponding to 60 – 70% of their individual heart rate maximum.
(ii) Progression. It was necessary to retest everyone at 12 week to ensure that her personalized “training zone” had not altered owing to improved fitness. A new heart rate training zone was prescribed for those who had improved their fitness, to maintain the 60 – 7-% of maximum heart rate level of work in all their exercise classes for the duration of the study.
Exercise classes. Exercise classes consisted of pre- set aerobic routines including step- classes and aerobic exercise to music. The participants were asked to record their exercising heart rate at 10 minutes intervals during the organized classes. Activities outside the classes included dancing classes, swimming, jogging, and cycling for a small minority of participants and occurred mainly with subjects that were away for short periods of time (such as holidays). Guidelines were given in written format about forms of exercise and the required intensities.
Results: Results were submitted from the 17 women who completed the study. The compliance rate of the subjects completing the study over the 6 months was approximately 93% with occasional holiday and illness periods causing minor disruptions. On a few occasions some subjects performed additional exercise sessions – but when averaged over the 6-month period, 3 days per week was standard.
Fitness. Following the 6- month exercise training, there was an improvement in fitness, with significant increases in heart rate maximums.
Body morphology. There was no significant change in body weight following 6 months of exercise. Furthermore, body composition measurements by impedance and anthropometry did not significantly change following 6 months of exercise. Similarly, there were no significant changes in waist circumference, the waist- to- hip ratio (WHR), or the body mass index (BMI) after exercise. Significant decreases in both total and some regional fat depots were observed with whole- body MRI. There was a 6.4% decrease in the absolute amount of total body fat present. There were also significant decreases in the amount of subcutaneous and internal fat. The biggest decrease was in the level of visceral fat, which was reduced by 25% following exercise.
Discussion: In this study we showed that a moderate exercise program (only 3 days a week) had a significant effect on the body fat content of non- obese sedentary healthy women. Furthermore there was a preferential loss of fat from certain fat depots. These changes were observed even though there were no significant changes in body weight, BMI, waist circumference, or WHR. The changes in body fat content reported in this cohort of subjects were only detected using whole- body MRI, probably because MRI is the only technique that can measure total and regional adipose tissue directly. Anthropometry and impedance only provide an indirect measure of body fat and are therefore unable to detect regional changes. Furthermore, the most significant changes detected in this study were from internal fat depots which overall correspond to less than 20% of total body fat. Therefore, even a significant decrease in fat from a small depot may be missed in the total body fat measurement.
(Preferential loss of visceral fat following aerobic exercise, measured by MRI. Lipids. 2000 July. p.769- 76)
The majority of research shows that individuals including physical activity as part of a weight loss strategy are far more likely to keep in shape than those who rely on dieting alone. Thus, to really reap the benefits of weight loss, one must abide not only to a diet, but rather a diet combined with aerobic exercise. (www.thefactsaboutfitness.com/print/1jan2001_print.htm)
If one can simply walk for 30 minutes a day, their heart rate will sky rocket, thus triggering an onset of events; those being a raised metabolism, their muscle burning fat, and an overall fat loss. A typical program normally consists of steady state aerobic exercise (such as cycling or walking) at 70% – 80% of maximum heart rate. One’s heart rate can be determined by merely measuring the pulse at the carotid artery on the neck or on the inside of the wrist using the first two fingers of one hand. It is easiest to count pulse beats for 10 seconds, and then multiply by six for the per- minute total. The maximum heart rate per minute for a particular individual can be calculated by subtracting one’s age from 220. This type of workout should last anywhere between 20 and 60 minutes. (http://health.msn.com)
The minimal objectives of a weight loss and management program are: to prevent further weight gain, to reduce body weight, and to permanently maintain a lower body weight. Regular physical activity is a well- recognized tool for long-term weight maintenance because it contributes to increased energy expenditure by burning calories (although generally a small amount) contributing to weight loss. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Thirty to forty- five minutes of physical activity of moderate intensity, performed 3 to 5 days a week, is encouraged for weight loss purposes. All adults should set a long- term goal to accumulate at least 30 minutes or more of moderate- intensity physical activity on most, and preferably all days. It appears that as long as the increase in energy expenditure is sufficient, low- intensity endurance exercise is likely to generate beneficial metabolic effects that would be essentially similar to those produced by high- intensity exercise. (Exercise in weight management of obesity. Cardiology Clinics. 2001 Aug. p.459 –70)
Thus, to summarize what one should do in order to have permanent weight loss is to follow this course: Eat foods that are healthy and have a good nutrient base; exercise at least 30 minutes for 4 days a week; and most importantly, stick to it. Following these three keys is the only way that one can be assured permanent weight loss over a prolonged period of time.
8 Amazing Exercise Bonuses. 1999 Health Ink Communications. http://health.msn.com/printing/article/1758.healthink-233.html
Balance the food you eat with physical activity – maintain or improve your weight. http://www.nalusda.gov/fnic/dga/dga95/weight.html
Basic Aerobic Exercise Principles – For Improved Health and Fitness. http://www.bodytrends.com/gourley.htm
Does aerobic exercise really speed up fat loss? Christian Finn’s Facts About Fitness. http://www.thefactsaboutfitness.com/print/1jan2001_print.htm
Evaluation of a modified cognitive- behavioural programme for weight management. Rapoport L; Clark M; Wardle J. International Journal of Obesity Related Metabolic Disorders. Dec. 2000; 24 (12): 1726 – 37.
Exercise. March 1999. http://health.msn.com
Exercise in weight management of obesity. Poirier, P.; Despres JP. Cardiology clinics. Aug. 2001; 19 (3): 459 – 70.
Preferential loss of visceral fat following aerobic exercise, measured by magnetic resonance imaging. Thomas EL; Brynes AE. Lipids. July 2000; 35 (7): 769 – 76.
Watching your weight. The WorkCare Group, Inc. and Health Ink & Vitality Communications. (2000) http://content.health.msn.com/content/article/3172.11523
What Effect Does Exercise Have on Obesity and Weight Loss? From Well- Connected Report: Exercise. March 2001. www.well-connected.com
What is Aerobic Exercise and Why should I do it? Lisa Balbach. http://k2.kirtland.cc.mi.us/~balbachl/aeroprin.htm
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