Intensified lifestyle intervention with exercise as a treatment of severe obesity and prevention of cardiometabolic risks

Thesis event information

Date and time of the thesis defence

Topic of the dissertation

Intensified lifestyle intervention with exercise as a treatment of severe obesity and prevention of cardiometabolic risks

Doctoral candidate

Master of Health Sciences Kaisu Kaikkonen

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Population Health (PopH)

Subject of study



Docent Katja Borodulin, Age Institute


Professor Sirkka Keinänen-Kiukaanniemi , University of Oulu

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Severely obese working-age people lost weight and the risk of cardiometabolic diseases decreased with enhanced lifestyle guidance and exercise.


The prevalence of obesity is increasing worldwide despite a rise in therapeutic interventions to
address this epidemic. However, there is a dearth of evidence-based non-surgical treatment
guidelines for severe obesity. The aim of this three-year randomized, controlled trial was to
elucidate the role of physical activity (PA) in the treatment of severe obesity. First, we studied the association of lifelong PA, aerobic fitness, and cardiac autonomic function by heart rate variability in severely obese adults. Secondly, we investigated the long-term effects of a three-month intensified behavioral modification (iBM) with exercise on glucose tolerance. Thirdly, we aimed to find out whether the timing of the exercise implemented at the weight loss phase of the intervention affects weight loss and waist circumference reduction (WC) from baseline. Finally,
we evaluated whether a three-month exercise intervention combined with iBM has long-term
effects on weight loss, weight maintenance, and reduction of WC over a three-year follow-up.
120 volunteers (mean BMI 36.8) were randomized into three intervention groups and a control
group. All intervention groups were offered intensified behavioral weight loss guidance.
According to previous studies, weight loss often stops and re-weighting begins after six months of
intervention; we thus added exercise to the protocol of one group right at the beginning of the
intervention and to another group after six months. Supervised three-month heart rate-controlled
exercise training was implemented as circuit weight training. The weight loss period lasted 12
months, and the weight maintenance period lasted 24 months.
Lifetime physical activity and aerobic fitness were positively associated with cardiac
autonomic function. During the trial, iBM alone and combined with exercise led to clinically
significant weight loss and long-term weight control. Increasing exercise right at the beginning of
the weight loss period reduced abdominal obesity, promoted weight management, improved
glucose metabolism, and reduced cardiometabolic risk in severely obese adults. Circuit weight
training was well suited for severely obese individuals.
As a conclusion of this thesis, we emphasize the importance of PA in the treatment of severe
obesity in adults. More intensive lifestyle interventions including exercise at the onset of the
treatment should be implemented for severely obese adults.
Last updated: 23.1.2024