Appetite 69 (2013) 168173

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Appetite
journal homepage: www.elsevier.com/locate/appet

Research report

Aerobic training (AT) is more effective than aerobic plus resistance

training (AT + RT) to improve anorexigenic/orexigenic factors in obese
adolescents q
June Carnier a,, Marco Tlio de Mello a,b,c, Carolina Ackel-DElia a, Flavia Campos Corgosinho a,
Raquel Munhoz da Silveira Campos a, Priscila de Lima Sanches a, Deborah Cristina Landi Masquio a,
Carlos Roberto Bueno Jnior a, Aline de Piano Ganen a, Aniela C. Martins a, Danielle Arisa Caranti d,e,
Lian Tock a, Ana Paula Grotti Clemente a, Sergio Tuk b,c, Ana R. Dmaso a,d,e,
a

Programa de Ps-Graduao em Nutrio, Universidade Federal de So Paulo UNIFESP, Brazil

Departamento de Psicobiologia, Universidade Federal de So Paulo UNIFESP, So Paulo, Brazil
Associao Fundo de Incentivo Pesquisa, Universidade Federal de So Paulo UNIFESP, So Paulo, Brazil
d
Departamento de Biocincias, Universidade Federal de So Paulo UNIFESP, So Paulo, Brazil
e
Programa de Ps-Graduao Interdisciplinar em Cincias da Sade, Universidade Federal de So Paulo UNIFESP, So Paulo, Brazil
b
c

a r t i c l e

i n f o

Article history:
Received 26 September 2012
Received in revised form 25 May 2013
Accepted 27 May 2013
Available online 10 June 2013
Keywords:
Aerobic training
Resistance training
Neuropeptides
Obesity

a b s t r a c t
Background: The regulation of energy balance is inuenced by physical exercise. Although some studies
show a stimulation of hormones related to food intake, others show that exercise provides satiety. Aim:
The aim of this study was to compare the effects of aerobic training (AT) and aerobic plus resistance training (AT + RT) on anorexigenic and orexigenic factors in obese adolescents undergoing interdisciplinary
weight loss therapy. Methods: A total of 26 obese adolescents, aged 1519 years with BMI P P95 were
submitted to 12 months of interdisciplinary intervention (clinical support, nutrition, psychology and
physical exercise) and divided into two groups, aerobic training (AT) (n = 13) or aerobic plus resistance
training (AT + RT) (n = 13), which were matched according to gender and body mass. Blood samples were
collected to analyze orexigenic factors (AgRP, NPY, MCH) and the anorexigenic factor alpha-MSH. Results:
The AT and AT + RT groups signicantly reduced body mass, body mass index and body fat mass (kg) during the therapy. The AT group showed no signicant changes in body lean mass (kg), whereas the AT + RT
group showed an increase in body lean mass (kg) during the interdisciplinary intervention. There was an
increase in AgRP levels (ng/ml) only in the AT + RT group after 6 months of interdisciplinary intervention
compared with baseline condition. Conversely, a-MSH levels (ng/ml) increased only in the AT group after
12 months of interdisciplinary intervention compared with baseline condition. Conclusion: Aerobic training (AT) as part of an interdisciplinary therapy is more effective than aerobic plus resistance training
(AT + RT) to improve secretion of anorexigenic/orexigenic factors in obese adolescents.
2013 Elsevier Ltd. All rights reserved.

Introduction
An interdisciplinary intervention, incorporating both psychological and physiological components, is important to promote
the reduction of body mass, blood pressure and coronary diseases
(Carnier et al., 2010; Sanches et al., 2012). Thus, physical exercise
has an important role in helping with weight loss, as well as main-

q
Acknowledgments: We would like to thank AFIP, CAPES (AUX-PE-PNPD 2566/
2011), CNPq, CEMSA, UNIFESP, FAPESP (CEPID/Sono no. 9814302-3), FAPESP (2006/
00684-3; 2008/53069-0; 2011/50356-0; 2011/50414-0) and the patients. Conicts
of interest: The authors have nothing to disclose.
Corresponding authors.
E-mail addresses: junecarnier@gmail.com (J. Carnier), ana.damaso@unifesp.br
(A.R. Dmaso).

0195-6663/$ - see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.appet.2013.05.018

taining increased energy expenditure (Foschini et al., 2010; Lus

Griera et al., 2007). However, a deeper understanding of the connections between physical activity and appetite is needed to optimize treatment of patients with obesity.
There are many factors involved in hunger and satiety signals.
Leptin, a key point of this regulation, is secreted by adipose tissue
and transported to the brain, where it crosses the blood-brain barrier and binds to its specic receptor (OB-R) in two neuronal populations in the arcuate nucleus (ARC) in the hypothalamus. The
neurons pro-opiomelanocortin (POMC), and cocaine- and amphetamine-regulated transcript (CART) stimulate the expression of amelanocyte-stimulating hormone (a-MSH) secreting neurons
and inhibit the expression of neuropeptide Y/agouti-related protein (NPY/AgRP) (Boguszewski, Paz-Filho, & Velloso, 2010; Diguez,
Vazquez, Romero, Lpez, & Nogueiras, 2011).

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J. Carnier et al. / Appetite 69 (2013) 168173

These primary targets of leptin signaling communicate with

second-order neurons in other hypothalamic nuclei, especially in
the paraventricular nucleus and lateral hypothalamus, to stimulate
the expression of anorexigenic neurotransmitters, including corticotropin-releasing hormone (CRH) and thyrotropin-releasing hormone (TRH), and to inhibit orexigenic pathways, including orexin
and melanin-concentrating hormone (MCH). The nal biological
actions of leptin are inhibition of food intake and stimulation of energy expenditure (Boguszewski et al., 2010; Diguez et al., 2011).
This complex system of regulation of energy balance is inuenced by physical exercise. Although some studies show a stimulation of hormones related to food intake, others show that exercise
provides satiety (Cook & Schoeller, 2011). Understanding the energy balance effects of different types of physical exercise could
help with the treatment of obese patients.
Aerobic training (AT) and aerobic plus resistance training
(AT + RT) are the exercise training programs most studied for the
treatment of obesity. The relationship between the type of exercise
performed and food intake is not very clear in the literature. Thus,
the aim of this study was to compare the effects of both programs
as part of an interdisciplinary therapy as measured by AgRP, NPY,
MCH and a-MSH levels in obese adolescents. We hypothesized
that there would be no differences in the energy balance regulation
between both types of exercise.

Methods
Study population
A total of 134 adolescents were selected to participate of the
present study. They were selected from GEO (Interdisciplinary
Obesity Program) of Universidade Federal de So Paulo UNIFESP
in 2010.
Of these 134 participants, we excluded 74 (36 from the AT
group and 38 from the AT + RT group) because they did not complete the therapy for reasons such as starting a professional job,
changes in school schedule, lack of motivation and lack of money
for transportation. Additionally, participants who did not perform
all necessary examinations in the three stages of evaluation and
who did not complete 75% of all therapies were also excluded.
Forty-seven of the remaining 60 obese adolescents were initially
included in the AT + RT group and 13 were in the AT group. To evaluate the same number of volunteers in each group, the 13 patients
of the AT group were matched according to gender and body mass
with volunteers from the AT + RT group. Thus, a total of 26 obese
adolescents were evaluated in this study (13 adolescents performed the AT exercises and 13 adolescents performed the AT + RT
exercises). There were ve boys and eight girls in each group (AT
and AT + RT group) (Fig. 1).
The inclusion criteria for participating in this program for weight
loss were as follows: post-pubertal adolescents presenting with
obesity who were healthy enough to perform physical activity and
available to participate in the program for 1 year. All adolescents
were aged from 15 to 19 years, presented with obesity (BMI > 95th
percentile, according to the Center for Disease Control and Prevention) and were considered post-pubertal (Tanner Stage = 5). An
endocrinologist assessed the Tanner stage, appointing the value that
best identied the stage of sexual maturation for each adolescent
(Tanner & Whithouse, 1976). All adolescents completed the effort
electrocardiogram maximum test until exhaustion to verify whether
they could safely perform physical exercise. The non-inclusion criteria were limitations such as an identied genetic disease (e.g. Down
syndrome), metabolic or endocrine diseases, chronic alcohol consumption or previous use of drugs such as glucocorticoids and psychotropics or pregnancy (Fig. 2).

Fig. 1. Selection of volunteers for the study.

This study was performed in accordance with the principles of

the declaration of Helsinki and was formally approved by the Ethical Committee of the Universidade Federal de So Paulo UNIFESP
(#0135/04). Informed consent was obtained from all subjects and/
or their parents. This study was registered at clinicaltrials.gov
(NCT01358773).
Research design
The volunteers were submitted to 1 year of interdisciplinary
intervention (clinical support, nutrition, psychology and physical
exercise) and divided into two groups, aerobic training (AT) or aerobic plus resistance training (AT + RT) (Fig. 2). These aspects of
therapy will be described further below. During the rst month,
the adolescents were submitted for evaluations. Thereafter, they
started the interdisciplinary weight loss program. The same evaluation procedures were performed after short (6 months) and
long-term (12 months) therapy (Dmaso, de Piano, Tock, & Srirajaskanthan, 2009). All interventions and evaluations were conducted in the CEPE (Centro de Estudos em Psicobiologia e
Exerccio) from AFIP, where some research studies of the Universidade Federal de So Paulo are conducted.
Measurements
Subjects were weighed to the nearest 0.1 kg on the Filizola scale
while wearing light weight clothing and no shoes. Height was measured to the nearest 0.5 cm using a wall-mounted stadiometer
(Sanny, model ES 2030). Body mass index (BMI) was calculated
as the body weight (wt) divided by height (ht) squared (wt/ht2).
Body composition was measured by air-displacement in a BOD

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J. Carnier et al. / Appetite 69 (2013) 168173

Fig. 2. Diagram of weight loss interdisciplinary therapy.

POD body composition system (version 1.69, Life Measurement

Instruments, Concord, CA) (Fields, Hunter, & Goran, 2000).
Analyses of food intake were made by 3 days of recordatory inquiry. With the help of their parents, each adolescent was asked to
record his or her diet over a period of 3 days, including 2 days during the week and 1 day of the weekend, at the beginning of the
study and at 6 and 12 months. Portions were measured in terms
of familiar volumes and sizes. Dietary data for all individuals were
transferred to a computer by the same nutritionist, and the nutrient composition was analyzed by a PC program developed at the
Universidade Federal de So Paulo (Nutwin software, for Windows,
1.5 version, 2002).
Blood samples were collected in the outpatient clinic around
8:00 a.m. after an overnight fast. Serum AgRP, NPY, MCH and
a-MSH concentrations were measured using a commercially
available enzyme-linked immune sorbent assay (ELISA) kit from
Phoenix Pharmaceuticals (Belmont, CA) according to the manufacturers instructions.
Physical therapy
All adolescents performed 1 year of physical exercise three
times a week. All sessions were individually supervised by an
experienced sports physiologist. During the exercise sessions, the
adolescents heart rates were continuously monitored by cardiometer (PolarModel FS1 dark blue) at intervals of 5 min during all
training sessions. The exercise program was based on recommendations from the ACSM (2009).
Aerobic training: During the year of therapy, the adolescents in
the AT group followed a personalized aerobic training program of
60 min duration three times a week under the supervision of a
sports physiologist. The aerobic exercises were performed at the
cardiac frequency intensity of the ventilatory threshold I
(4 bpm) on a motor-driven treadmill (Life FitnessModel TR
9700HR). After every 6 months of training, aerobic tests were performed to re-assess physical capacity and to individually adjust
physical training intensity.
Aerobic training plus Resistance training: During the year of therapy, the adolescents in the AT + RT group followed a personalized
30 min aerobic training program plus 30 min of resistance training

three times a week under the supervision of a sports physiologist.

The aerobic exercises were performed as described above. Additionally, the adolescents worked each of the main muscle groups
with resistance training. The exercises performed during the muscle training program were the bench press, pulley (lat pull-down),
leg-press, curl, ankle extension machine (sitting), curl machine for
triceps, abdominal machine and trunk extensor machine. All adolescents had a period of 2 weeks of adaptation to training to learn
the movements, performing three sets of 1520 RM for each exercise. After this adaptation period, the training load was adjusted
and every 8 weeks, volume and intensity were adjusted inversely
to decrease the number of repetitions from 1520 to 1012 and
68, respectively, for three sets.

Clinical therapy
All obese adolescents were evaluated by the endocrinologist in
the presence of their parents once each month. The doctor monitored and evaluated all clinical exams of adolescents and treated
any health problems during therapy. The medical follow-up included the initial medical history as well as a physical examination
of blood pressure, heart rate and body weight; additionally, patients were checked for their adherence to all interdisciplinary
therapies. At all of these appointments with the doctor, the entire
GEO team was also present. The team discussed with the patients
and their parents some possible changes in lifestyle to promote
their health status.

Psychological therapy
All adolescents participated in weekly psychological orientation
group sessions (15 people per session) based on the psychodynamic approach with one trained psychologist. At these sessions,
body image, low self-esteem, family problems, and eating disorders such as bulimia, anorexia nervosa, and binge eating, including
their signals, symptoms and consequences for health were discussed, in addition to other topics. Individual psychological therapy was recommended when behavioral alterations were found
to be necessary.

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J. Carnier et al. / Appetite 69 (2013) 168173

Nutritional therapy
The adolescents participated in group and individual interventions. The themes of group interventions were weight loss diets,
the food pyramid, dietary analysis, diet and light concepts, fat
and cholesterol, eating disorders, fast foods, nutrition labeling,
how to prepare a healthy snack and nutrition tips for special events
(parties, barbecues, etc.). The lessons were taught by trained nutritionists to encourage the adolescents to follow healthy eating habits. Furthermore, all adolescents were interviewed individually
twice a month. Energy intake was set at the levels recommended
by the dietary reference intake for subjects with low levels of physical activity of the same age and gender (National Research Council
& Food & Nutrition Board, 1989).
Physiotherapy
The adolescents participated both in group and individual interventions with two physical therapists once a week. Individual consultations were also performed if the patient had any injuries. The
themes of group interventions were postural orientation, diaphragmatic breathing, hydrotherapy, RPG, isostretching, balance and
stretching.
Statistical analyses
Distributional assumptions were veried by the Kolmogorov
Smirnov test. An analysis of variance for repeated measures (ANOVA) was used to compare both groups at the same time and each
group during the therapy. For conrmation Tukeys post hoc test
was used. Data were analyzed by means of STATISTICA version
7.0 for Windows, with signicance set at p < 0.05 and expressed
as the mean S.D.

Results
It was found that the AT group signicantly (p < 0.05) reduced
body mass and BMI after 1 year of therapy. For this group, the body
fat mass (kg) was reduced signicantly (p < 0.05) after both
6 months and after 1 year of therapy. The AT group showed no signicant changes in body lean mass (kg), NPY or MCH levels during
the interdisciplinary intervention (Table 1).
Analyzing the AT + RT group, the results show that this group
signicantly (p < 0.05) reduced body mass, BMI and body fat mass
(kg) after both 6 months and after 1 year of therapy when compared with the baseline conditions. In addition, the body lean mass
(kg) increased signicantly (p < 0.05) after 1 year of therapy when
compared with baseline conditions. There was no signicant
change in NPY or MCH concentrations in either group during the
interdisciplinary intervention (Table 1).

In Fig. 3, the results show that the AT group exhibited signicantly (p < 0.05) increased values of a-MSH after 1 year of interdisciplinary therapy. Furthermore, the a-MSH levels were
signicantly (p < 0.05) higher after 1 year compared with after
6 months of therapy. However, the levels of AgRP did not change
signicantly during the therapy. For the AT + RT group, it was observed that the levels of AgRP increased signicantly (p < 0.05)
after 6 months of therapy and then reduced (p < 0.05) after 1 year
of therapy. Additionally, the levels of serum a-MSH after 6 months
and 1 year of therapy were different (p < 0.05) when compared between groups (Fig. 3).
In relation to the diet, both groups signicantly (p < 0.05) reduced similarly their total energy intake after 6 months and 1 year
of therapy. The AT + RT group signicantly (p < 0.05) reduced their
intake of lipids and protein after 6 months and after 1 year of interdisciplinary therapy. The AT group showed a signicant (p < 0.05)
reduction in carbohydrate intake after 6 months and after 1 year
(Table 2).

Discussion
One of the most interesting results in the present study was the
increase of AgRP concentrations in the AT + RT group after
6 months of intervention, followed by a reduction in AgRP levels
after 1 year of therapy. This result demonstrates that this group
had greater difculty in controlling their food intake at 6 months
of therapy due to increased secretion of the orexigenic factor AgRP,
which is involved with hunger signals at the hypothalamic arcuate
nucleus, but this effect was reversed by the end of the therapy (Andrews, 2011). Despite this difculty of the AT + RT group in controlling hunger, based on the concentrations of AgRP, this group
showed a reduction in total energy intake, lipids and protein after
6 months and after 1 year of interdisciplinary therapy. Few studies
have been conducted to correlate types of exercise with anorexigenic and orexigenic factors. An experimental study found that
6 weeks of aerobic exercise promoted a decrease in plasma ghrelin
and increase of AgRP (Ghanbari-Niaki, Abednazari, Tayebi, Hossaini-Kakhak, & Kraemer, 2009). These results do not totally agree
with the results found in the present study, as we found an increase of AgRP in the AT + RT group, but not in the AT group. The
difference between these results may be due to the type of treatment provided in the two studies. Although the study of NiakiGhanbari et al. evaluated the effect of isolated aerobic exercise in
mice, the present study evaluated the effect of an interdisciplinary
intervention in obese adolescents. Thus, other factors such as diet
and psychological factors may also inuence the results shown in
this paper. Conversely, corroborating our ndings, a study showed
that circuit-resistance exercise was able to increase plasma AgRP
levels, suggesting that this type of physical activity induces hyper-

Table 1
Anthropometric, body composition and neuropeptides values of aerobic training (AT) and aerobic training (AT) + resistance training (RT) groups at baseline and after 6 and
12 months of therapy.
Aerobic training (AT)
Baseline
Body mass (kg)
BMI (kg/m2)
Body fat mass (kg)
Body lean mass (kg)
NPY (ng/ml)
MCH (ng/ml)

93.92 14.06
35.36 3.95
39.57 9.47
54.21 13.31
1.08 1.29
8.11 4.41

Data are presented as mean SD.

a
Baseline 6 months.
b
Baseline 1 year.
c
6 months 1 year.

Aerobic training (AT) + resistance training (RT)

6 months
88.36 13.22
33.24 4.04
33.01 12.15a
53.19 11.88
6.32 6.50
7.12 2.71

1 year

Baseline
b

85.30 12.84
32.21 4.52b
31.46 12.69b
53.93 11.74
2.20 2.54
7.18 4.22

94.62 13.86
34.41 3.53
42.30 8.16
52.31 7.46
2.22 3.99
4.79 2.12

6 months
86.36 14.03
31.33 3.88a
32.63 8.32a
53.72 8.52
4.58 7.35
3.39 0.73

1 year
a

83.94 12.64b
30.35 4.29b
28.28 9.93b
55.67 7.28b
2.75 5.10
5.10 1.99

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J. Carnier et al. / Appetite 69 (2013) 168173

Fig. 3. AgRP (ng/ml) and a-MSH (ng/ml) values of aerobic training (AT) and aerobic training (AT) + resistance training (RT) groups at baseline and after 6 and 12 months of
therapy.

Table 2
Food intake values of aerobic training (AT) and aerobic training (AT) + resistance training (RT) groups at baseline and after 6 months and 1 year of therapy.
Aerobic training (AT)

Energy (kcal)
Protein (g)
Carbohydrate (g)
Lipids (g)

Aerobic training (AT) + resistance training (RT)

Baseline

6 months

1 year

Baseline

6 months

1 year

1857.01 357.61
95.10 21.39
248.57 49.40
49.41 19.99

1251.11 89.11a
72.54 9.32
168.31 18.75a
34.56 4.20

1318.14 203.25b
86.86 23.68
158.58 30.88b
37.22 10.78

1902.67 508.68
66.80 43.67
182.13 105.28
50.50 28.33

1141.08 402.74a
47.60 14.28a
162.22 56.92
33.91 14.86a

1310.79 330.69b
58.29 20.02b
197.49 48.02
33.48 11.51b

Data are presented as mean SD. Signicance set at p < 0.05.

a
Baseline 6 months.
b
Baseline 1 year.
c
6 months 1 year.
#
Difference between AT and AT + RT groups at the same time.

phagia to induce fuel recovery after exercise (Ghanbari-Niaki,

Nabatchian, & Hedayati, 2007).
It also has been demonstrated that specic types of nutrients
can inuence some factors related to energy balance (Misra, Tsai,
Mendes, Miller, & Klibanski, 2009). Some authors have shown that
obese rats fed a high-fat diet exhibited a decrease in the number of
neurons carrying a-MSH and CART peptides in the arcuate nucleus
of the hypothalamus as well as higher energy intake (Tian et al.,
2004). On the contrary, other scientists showed that 2 or 12 weeks
of feeding a high-fat diet did not change hypothalamic a-MSH content in rats (Hansen, Schith, & Morris, 2005). In the present study,
we veried that the AT + RT group signicantly reduced the intake
of lipids and did not show signicant changes in a-MSH levels after
1 year of interdisciplinary therapy, whereas the AT group did not
show changes in lipid intake but exhibited an increase in a-MSH
levels throughout the treatment. It is important to consider that
neither of the two groups consumed macronutrients above the recommended values as determined by the Dietary reference intake
for energy, ber, fatty acids, and protein (2002/2005). However,
this study is limited by the use of the 3-day food record, the instrument that assessed the dietary intake of the volunteers in this
study. As such, the teenagers in the study may have omitted certain information about their diets, underestimating the amounts
of macronutrients consumed.
In addition Prince, Brooks, Stahl, and Treasure (2009) showed
that individuals with eating disorders had higher baseline concentrations of ghrelin (an appetite stimulant), peptide YY and cholecystokinin (appetite inhibitors) compared with individuals
without eating disorders. These results suggest that feeding-

related behaviors, such as fasting and purging, can also inuence

the levels of orexigenic and anorexigenic factors.
Another interesting result found in the present study was the
increase of a-MSH concentrations after long-term therapy only in
obese adolescents who underwent AT. We did not nd any study
to compare with our ndings that evaluated the effect of exercise
on the concentrations of a-MSH in obese adolescents. However,
Alves et al. (2012) veried that healthy elderly male volunteers
showed a reduction of serum a-MSH levels after 3 months of aerobic training. It is important to consider that this study was conducted with older, non-obese people.
These factors could explain the difference in ndings between
the present study and the study performed by Alves et al. In addition, some studies have shown that the reduction of body mass by
physical training promotes an increase of PYY in obese subjects.
PYY is a hormone secreted by the intestine postprandially which
causes a decrease in appetite and food intake. Studies using a
short-term and long-term intervention found the same result of increased satiety after aerobic exercise (Martins, Kulseng, King,
Holst, & Blundell, 2010; Stensel, 2010). These studies correlated
with our results in which we found a reduction of body mass
accompanied by an increase in satiety in the AT group.
Although we found that aerobic training (AT) as part of an interdisciplinary therapy was more effective to improve the energy balance of obese adolescents, the two intervention groups showed no
difference in weight loss at 6 months of treatment and at the end of
the intervention. It is important to emphasize that we are not evaluating the effects of exercise as an individual component of the
treatment plan because the volunteers also participated in other

J. Carnier et al. / Appetite 69 (2013) 168173

interventions such as nutrition modication, which helped with

weight loss during treatment. Thus, it appears that the stimulation
of orexigenic and anorexigenic factors did not effectively contribute to either group exhibiting a worse or better outcome after
interdisciplinary therapy.
We must also consider that the AT group showed a signicant
reduction in lean body mass (kg), whereas the AT + RT group
showed a signicant increase in lean body mass (kg) during the
therapy. This factor could partially explain the reason for both
studied groups exhibiting similar results for weight loss after the
intervention, despite the stimulation of anorexigenic factors only
in the AT + RT group. In accordance with scientic literature, resistance training results in increased fat-free mass and therefore energy expenditure, contributing to a positive impact on energy
balance and fat oxidation (Kirk et al., 2009).
Because these volunteers had the guidance of and treatment by
other health professionals, subjects in the AT + RT group were able
to control hunger and reduce energy intake during the treatment
despite the unfavorable values of orexigenic and anorexigenic factors for weight loss (Campos et al., 2012; Tock et al., 2010). In addition, previous studies from our group demonstrated that the
AT + RT group showed more effective improvements in adiponectinemia and metabolic proles, suggesting that this type of training
exercise can be important in controlling the metabolic syndrome in
adolescents (de Mello et al., 2011).
Although we believe that this study provides relevant ndings,
the lack of a normal-weight control group and the small number of
volunteers evaluated at the end of the study (due to the loss of volunteers during the long-term intervention of 1 year) are the limitations of the study. It is important to highlight that without a
control group, we cannot know the effects of natural uctuations
in the analyzed variables.
In conclusion, aerobic training (AT) as part of an interdisciplinary therapy is more effective than aerobic plus resistance training
(AT + RT) to improve anorexigenic/orexigenic factors in obese
adolescents.
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