Short-term blood pressure (BP) variability predicts cardiovascular complications in hypertension, but its association with large-artery stiffness is poorly understood and confounded by methodologic issues related to the assessment of BP variations over 24 hours. Carotid-femoral pulse wave velocity (cfPWV) and 24-hour ambulatory BP were measured in 911 untreated, nondiabetic patients with uncomplicated hypertension (learning population) and in 2089 mostly treated hypertensive patients (83% treated, 25% diabetics; test population). Short-term systolic BP (SBP) variability was calculated as the following: (1) SD of 24-hour, daytime, or nighttime SBP; (2) weighted SD of 24-hour SBP; and (3) average real variability (ARV), that is, the average of the absolute differences between consecutive SBP measurements over 24 hours. In the learning population, all of the measures of SBP variability showed a direct correlation with cfPWV (SD of 24-hour, daytime, and nighttime SBP, r =0.17/0.19/0.13; weighted SD of 24-hour SBP, r =0.21; ARV, r =0.26; all P <0.001). The relationship between cfPWV and ARV was stronger than that with 24-hour, daytime, or nighttime SBP (all P <0.05) and similar to that with weighted SD of 24-hour SBP. In the test population, ARV and weighted SD of 24-hour SBP had stronger relationships with cfPWV than SD of 24-hour, daytime, or nighttime SBP. In both populations, SBP variability indices independently predicted cfPWV along with age, 24-hour SBP, and other factors. We conclude that short-term variability of 24-hour SBP shows an independent, although moderate, relation to aortic stiffness in hypertension. This relationship is stronger with measures of BP variability focusing on short-term changes, such as ARV and weighted 24-hour SD.

Summary: This systematic review examined the effect of exercise training interventions on physical fitness in adults with overweight or obesity and compared the effectiveness of different types of exercise training. Four electronic databases were searched. Articles were included if they described randomized controlled trials of exercise training interventions and their effect on maximal oxygen consumption or muscle strength in adults with overweight or obesity. Changes in outcome parameters were analyzed using random effects meta‐analyses for different training types (aerobic, resistance, combined aerobic plus resistance, and high‐intensity interval training). Eighty‐eight articles satisfied the inclusion criteria of which 66 (3964 participants) could be included in the meta‐analyses. All training types increased VO_2max (mean difference 3.82 ml/min/kg (95% CI 3.17, 4.48), P < 0.00001; I² = 48%). In direct comparisons, resistance training was less effective in improving VO_2max than aerobic training, HIIT was slightly more effective than aerobic training, and no difference between aerobic and combined aerobic plus resistance training was found. For muscle strength benefits, incorporation of resistance exercise in the training program is indicated. Exercise training increases VO_2max and muscle strength in adults with overweight or obesity. Differences between training types should be weighed with other needs and preferences when health professionals advise on exercise training to improve physical fitness.

Summary: We aimed to assess the effectiveness of exercise training programs in adults with severe obesity undergoing bariatric surgery. A systematic search of controlled trials published up to October 2019 that assigned participants to either a preoperative or postoperative exercise training group or a nonexercise group was performed. Meta‐analyses were conducted using random‐effects models. Twenty‐two training programs were assessed (18 performed after bariatric surgery). The effect of preoperative exercise training on postsurgery outcomes was reported in only one study. Compared with the control condition without exercise, postoperative exercise training led to higher weight loss (N = 14, mean difference [95% CI] = −1.8 [−3.2; −0.4] kg,P = 0.01), fat loss (N = 9,P = 0.01), increase in VO₂max (N = 8,P < 0.0001), and increase in muscle strength (N = 9,P < 0.0001). No significant effect was found on lean body mass (N = 11). Preliminary evidence suggests a beneficial effect of postoperative exercise training on bone mineral density (N = 3,P < 0.001) and weight maintenance after the end of the intervention (N = 2,P < 0.001) but no significant effect on quality of life (N = 2), habitual physical activity (N = 2), or cardiometabolic outcomes (N < 4). In conclusion, exercise training performed after bariatric surgery improves physical fitness and leads to a small additional weight and fat loss and may prevent bone loss and weight regain after bariatric surgery.

Summary: Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face‐to‐face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty‐two RCTs were included. Meta‐regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self‐monitoring of behavior (adjusted R²'s = 0.15–0.51). One BCT showed significant moderator effects on PA in face‐to‐face interventions, behavioral practice and rehearsal (adjusted R² = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face‐to‐face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self‐monitoring of behavior. In face‐to‐face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.

Summary: This systematic review examined the impact of exercise intervention programs on selected cardiometabolic health indicators in adults with overweight or obesity. Three electronic databases were explored for randomized controlled trials (RCTs) that included adults with overweight or obesity and provided exercise‐training interventions. Effects on blood pressure, insulin resistance (homeostasis model of insulin resistance, HOMA‐IR), and magnetic resonance measures of intrahepatic fat in exercise versus control groups were analyzed using random effects meta‐analyses. Fifty‐four articles matched inclusion criteria. Exercise training reduced systolic and diastolic blood pressure (mean difference, MD = −2.95 mmHg [95% CI −4.22, −1.68], p < 0.00001, I² = 63% and MD = −1.93 mmHg [95% CI −2.73, −1.13], p < 0.00001, I² = 54%, 60 and 58 study arms, respectively). Systolic and diastolic blood pressure decreased also when considering only subjects with hypertension. Exercise training significantly decreased HOMA‐IR (standardized mean difference, SMD = −0.34 [−0.49, −0.18], p < 0.0001, I² = 48%, 37 study arms), with higher effect size in subgroup of patients with type 2 diabetes (SMD = −0.50 [95% CI: −0.83, −0.17], p = 0.003, I² = 39%). Intrahepatic fat decreased significantly after exercise interventions (SMD = −0.59 [95% CI: −0.78, −0.41], p < 0.00001, I² = 0%), with a larger effect size after high‐intensity interval training. In conclusion, exercise training is effective in improving cardiometabolic health in adults with overweight or obesity also when living with comorbitidies.