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Aerobic exercise is most effective for fighting obesity-related inflammation

 
, medical expert
Last reviewed: 02.07.2025
 
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13 May 2024, 15:50

New research to be presented at this year's European Congress on Obesity (ECO) in Venice, Italy (12-15 May) reveals the anti-inflammatory properties of moderate to intense aerobic exercise in adults living with low-level inflammation due to obesity, illuminating its potential to prevent a host of metabolic diseases including type 2 diabetes and atherosclerosis (hardening of the arteries).

Excess fat accumulation in adipose tissue leads to chronic low-grade inflammation, which is characterized by chronically elevated levels of harmful compounds known as proinflammatory cytokines, which contribute to the development of metabolic diseases.

We know that exercise can reduce the risk of obesity-related complications, and that new weight-loss drugs such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for diabetes, are effective in reducing obesity and related disorders. In this study, we wanted to investigate whether combining exercise with GLP-1 RAs could reduce chronic low-grade inflammation in people with obesity, a process that underlies many chronic diseases and age-related conditions."

Signe Torekov, lead author, professor, University of Copenhagen in Denmark

In the randomized, double-blind, placebo-controlled S-LITE study, 195 Danish adults (mean age 42 years, 63% women) with obesity (BMI 32-43 kg/m²) but no history of diabetes followed an 8-week low-calorie diet (800 kcal/day) and lost at least 5% of their body weight (mean loss 13.1 kg).

Participants were then randomly assigned to receive one year of either placebo (usual activity plus placebo), exercise (at least 150/75 minutes of moderate/vigorous exercise per week, as recommended by WHO, plus placebo), liraglutide (3 mg/day plus usual activity), or a combination of exercise and liraglutide treatment to maintain weight loss.

Participants self-administered either placebo or liraglutide daily (depending on group).

The exercise program included two supervised sessions per week, primarily high-intensity cycling (assessed by heart rate), and participants were encouraged to complete two individual sessions per week to achieve a minimum of 150 minutes of activity per week.

Blood samples were collected before and after the low-calorie diet, as well as after a one-year treatment period to measure changes in known chronic inflammatory factors - inflammatory cytokines such as interleukins (IL-2, IL-6, IL-8, IL-10, IFN-γ) and tumor necrosis factor alpha (TNF-α).

After one year, patients in the liraglutide-only group had lost an average of an additional 0.7 kg; those in the exercise group had gained an average of 2.0 kg; and those in the placebo group had regained about half the weight they had lost (6.1 kg). However, those in the exercise and liraglutide group had lost an average of 3.4 kg.

Changes in inflammatory markers After the low-calorie diet, TNF-α levels increased by an average of 8.4%, and IL-10 levels by 11.7%. The remaining cytokines showed no significant changes after the dietary intervention. TNF-α is associated with apoptosis (cell death), and the authors suggest that rapid weight loss leads to a temporary increase in TNF-α as a marker of stress.

By the end of the one-year intervention period, the exercise group reduced IL-6 levels by an average of 31.9%, and by 18.9% compared to placebo. Chronically elevated IL-6 levels are associated with cardiovascular diseases such as atherosclerosis and insulin resistance. The exercise group also reduced IFN-γ levels by an average of 36.6%, and by 37.2% compared to placebo. IFN-γ is associated with insulin resistance in obesity.

The liraglutide and combination groups reduced IL-6 levels by an average of 17.3% and 19.9%, respectively, over the intervention period, but there were no significant differences compared with placebo. However, there were no changes in IFN-γ levels in the placebo, liraglutide, or combination groups.

No significant differences in plasma concentrations of IL-2, IL-8, IL-10, and TNF-α were observed between groups.

"Our results show that performing exercise as recommended is the most effective strategy for reducing chronic low-grade inflammation," says Professor Torekov. "Treatment with liraglutide did not reduce inflammation more than placebo, and adding liraglutide to exercise did not reduce inflammation further. These results highlight the benefits of moderate to intense exercise in reducing low-grade inflammation in obesity, which may help prevent related metabolic diseases."

The dropout rate was low. After one year, 41 of 49 randomized patients in the liraglutide group, 40 of 48 patients in the exercise group, 45 of 49 patients in the combination group, and 40 of 49 patients in the placebo group completed the study.

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