Changes in the Paradigm of Traditional Exercise in Obesity Therapy and Application of a New Exercise Modality: A Narrative Review Article

  • Hun-Young PARK Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea
  • Won-Sang JUNG Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea
  • Jisu KIM Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea
  • Hyejung HWANG Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea
  • Kiwon LIM Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea AND Department of Physical Education, Konkuk University, Seoul, Republic of Korea
Obesity, High-intensity interval training, Whole-body vibration training, Hypoxic therapy


Background: Obesity is recognized as an important global health problem that increases the risk of all-cause death. It is a major risk factor for various cardiovascular and metabolic diseases.

Methods: We conducted this review through searching the related literature plus internet links. 

Results: Recently, many researchers have been applying various efficient alternative exercise paradigms for treating obesity, such as high-intensity interval training, whole-body vibration training, and hypoxic therapy. Compared with moderate-intensity continuous training, high-intensity interval training involves a shorter exercise time but higher energy expenditure and excess post-exercise oxygen consumption via a higher exercise intensity and is effective for treating obesity. Whole-body vibration training effectively reduces the rate of fat production and accumulation through passive vibration of the whole body and improving the body composition, muscle function, and cardiovascular function of the obese population. Hypoxic therapy has been reported to improve obesity and obesity-related diseases through appetite loss, reduced dietary intake, increased energy consumption, improved glycogen storage and fatty acid oxidation, angiogenesis and left ventricle remodeling, decreased mechanical load, and reduced sarcopenia progression due to aging.

Conclusion: The new therapeutic exercise modalities, namely, high-intensity interval training, whole-body vibration training, and hypoxic therapy, are practical, useful, and effective for improving obesity and various metabolic and cardiovascular diseases induced by obesity.



1. Park HY, Kim J, Park MY, et al (2018). Ex-posure and exercise training in hypoxic conditions as a new obesity therapeutic modality: a mini review. J Obes Metab Syndr, 27:93-101.
2. Flegal KM, Kit BK, Orpana H, Graubard BI (2013). Association of all-cause mortality with overweight and obesity using stand-ard body mass index categories: a sys-tematic review and meta-analysis. JAMA, 309:71-82.
3. Poirier P, Giles TD, Bray GA, et al (2006). Obesity and cardiovascular disease: path-ophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol, 26:968-76.
4. Chin SH, Kahathuduwa CN, Binks M (2016). Physical activity and obesity: what we know and what we need to know. Obes Rev, 17:1226-44.
5. Ohkawara K, Tanaka S, Miyachi M, Ishika-wa-Takata K, Tabata I (2007). A dose-response relation between aerobic exer-cise and visceral fat reduction: systematic review of clinical trials. Int J Obes, 31:1786-97.
6. Shook RP (2016). Obesity and energy bal-ance: What is the role of physical activity? Expert Rev Endocrinol Metab, 11:511-20.
7. Verheggen RJ, Maessen MF, Green DJ, et al (2016). A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev, 17:664-90.
8. Wewege M, van den Berg R, Ward RE, Keech A (2017). The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes Rev, 18:635-46.
9. Elliott AD, Rajopadhyaya K, Bentley DJ, Beltrame JF, Aromataris EC (2015). In-terval training versus continuous exercise in patients with coronary artery disease: a meta-analysis. Heart Lung Circ, 24:149-57.
10. Liou K, Ho S, Fildes J, Ooi SY (2016). High Intensity Interval versus Moderate Inten-sity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters. Heart Lung Circ, 25:166-74.
11. Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002). Correlates of adults' participation in physical activity: review and update. Med Sci Sports Exerc, 34:1996-2001.
12. Roelants M, Delecluse C, Verschueren SM (2004). Whole-body-vibration training in-creases knee-extension strength and speed of movement in older women. J Am Geriatr Soc, 52:901-8.
13. Zago M, Capodaglio P, Ferrario C, Tarabini M, Galli M (2018). Whole-body vibration training in obese subjects: A systemic re-view. PLoS One, 13:e0202866.
14. Bogaerts ACG, Delecluse C, Claessens AL, et al (2009). Effects of whole body vibra-tion training on cardiorespiratory fitness and muscle strength in older individuals (a 1-year randomised controlled trial). Age Ageing, 38:448-54.
15. Lohman EB, Petrofsky JS, Maloney-Hinds C, Betts-Schwab H, Thorpe D (2007). The effect of whole body vibration on lower extremity skin blood flow in nor-mal subjects. Med Sci Monit, 13:CR71-6.
16. Maddalozzo GF, Iwaniec UT, Turner RT, Rosen CJ, Widrick JJ (2008). Whole-body vibration slows the acquisition of fat in mature female rats. Int J Obes, 32:1348-54.
17. Nam SS, Sunoo S, Park HY, Moon HW (2016). The effects of long-term whole-body vibration and aerobic exercise on body composition and bone mineral density in obese middle-aged women. J Exerc Nutrtion Biochem, 20:19-27.
18. Prisby RD, Lafage-Proust MH, Malaval L, Belli A, Vico L (2008). Effects of whole body vibration on the skeleton and other organ systems in man and animal mod-els: What we know and what we need to know. Ageing Res Rev, 7:319-29.
19. Rubin C, Turner AA, Mallinckrodt C, et al (2002). Mechanical strain, induced nonin-vasively in the high-frequency domain, is anabolic to cancellous bone, but not cor-tical bone. Bone, 30:445-52.
20. Girard O, Malatesta D, Millet GP (2017). Walking in hypoxia: An efficient treat-ment to lessen mechanical constraints and improve health in obese individuals? Front Physiol, 8:73.
21. Urdampilleta A, González-Muniesa P, Portil-lo MP, Martínez JA (2012). Usefulness of combining intermittent hypoxia and physical exercise in the treatment of obe-sity. J Physiol Biochem, 68:289-304.
22. Maillard F, Rousset S, Pereira B, et al (2016). High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes. Diabetes Metab, 42:433–41.
23. Shuster A, Patlas M, Pinthus JH, Mourtzakis M (2012). The clinical importance of vis-ceral adiposity: a critical review of meth-ods for visceral adipose tissue analysis. Br J Radiol, 85:1–10.
24. Zhang H, Tong TK, Qiu W, et al (2015). Ef-fect of high-intensity interval training protocol on abdominal fat reduction in overweight Chinese women: A random-ized controlled trial. Kinesiology, 47:57-66.
25. Welch N, McNaughton SA, Hunter W, Hume C, Crawford D (2009). Is the per-ception of time pressure a barrier to healthy eating and physical activity among women? Public Health Nutr, 12:888–95.
26. Rognmo Ø, Moholdt T, Bakken H, et al (2012). Cardiovascular risk of high- ver-sus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation, 126:1436–40.
27. Cardinale M, Bosco C (2003). The use of vibration as an exercise intervention. Ex-erc Sport Sci Rev, 31:3-7.
28. Cochrane DJ (2011). Vibration exercise: The potential benefits. Int J Sports Med, 32:75-99.
29. Delecluse C, Roelants M, Verschueren S (2003). Strength increase after whole-body vibration compared with resistance training. Med Sci Sports Exerc, 35:1033-41.
30. Bosco C, Colli R, Introini E, et al (1999). Adaptive responses of human skeletal muscle to vibration exposure. Clin Physiol, 19:183-7.
31. Jordan MJ, Norris SR, Smith DJ, Herzog W (2005). Vibration training: an overview of the area, training consequences, and fu-ture considerations. J Strength Cond Res, 19:459-66.
32. Adsuar J, B Del Pozo-Cruz, Parraca J, et al (2013). Vibratory Exercise Training Ef-fects on Weight in Sedentary Women with Fibromyalgia. Int J Med Sci Phys Act Sport, 13:295-305.
33. Milanese C, Piscitelli F, Zenti MG, et al (2013). Ten-week whole-body vibration training improves body composition and muscle strength in obese women. Int J Med Sci, 10:307-11.
34. Miyaki A, Maeda S, Choi Y, et al (2012). The addition of whole-body vibration to a lifestyle modification on arterial stiffness in overweight and obese women. Artery Res, 6:85-91.
35. Sañudo B, Alfonso-Rosa R, Del Pozo-Cruz B, et al (2013). Whole body vibration training improves leg blood flow and ad-iposity in patients with type 2 diabetes mellitus. Eur J Appl Physiol, 113:2245-52.
36. Vissers D, Verrijken A, Mertens I, et al (2010). Effect of long-term whole body vibration training on visceral adipose tis-sue: A preliminary report. Obes Facts, 3:93-100.
37. Figueroa A, Alvarez-Alvarado S, Ormsbee MJ, et al (2015). Impact of l-citrulline supplementation and whole-body vibra-tion training on arterial stiffness and leg muscle function in obese postmenopau-sal women with high blood pressure. Exp Gerontol, 63:35-40.
38. Severino G, Sanchez-Gonzalez M, Walters-Edwards M, et al (2017). Whole-body vi-bration training improves heart rate vari-ability and body fat percentage in obese Hispanic postmenopausal women. J Ag-ing Phys Act, 25:395-401.
39. So R, Eto M, Tsujimoto T, Tanaka K (2014). Acceleration training for improving phys-ical fitness and weight loss in obese women. Obes Res Clin Pract, 8:e201-e98.
40. Wilms B, Frick J, Ernst B, et al (2012). Whole body vibration added to endur-ance training in obese women - a pilot study. Int J Sports Med, 33:740-3.
41. Bellia A, SallõÁ M, Lombardo M, et al (2014). Effects of whole body vibration plus diet on insulin-resistance in middle-aged obese subjects. Int J Sports Med, 35:511-6.
42. Di Loreto C, Ranchelli A, Lucidi P, et al (2004). Effects of whole-body vibration exercise on the endocrine system of healthy men. J Endocrinol Invest, 27:323-7.
43. Giunta M, Cardinale M, Agosti F, et al (2012). Growth hormone-releasing ef-fects of whole body vibration alone or combined with squatting plus external load in severely obese female subjects. Obes Facts, 5:567-74.
44. Sartorio A, Spada A, Morabito F, Faglia G (1988). Different GH responsiveness to repeated GHRH administration in nor-mal children and adults. J Endocrinol Invest, 11:727-9.
45. Snitker S, Macdonald I, Ravussin E, Astrup A (2000). The sympathetic nervous sys-tem and obesity: role in aetiology and treatment. Obes Rev, 1:5-15.
46. Piché ME, Lapointe A, Weisnagel SJ, et al (2008). Regional body fat distribution and metabolic profile in postmenopausal women. Metabolism, 57:1101-7.
47. Premaor MO, Ensrud K, Lui L, et al (2011). Risk factors for nonvertebral fracture in obese older women. J Clin Endocrinol Metab, 96:2414-21.
48. Wu T, Gao X, Chen M, van Dam RM (2009). Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev, 10:313-23.
49. Netzer N, Strohl K, Faulhaber M, Gatterer H, Burtscher M (2013). Hypoxia-related altitude illnesses. J Travel Med, 20:247-55.
50. Hobbins L, Hunter S, Gaoua N, Girard O (2017). Normobaric hypoxic conditioning to maximize weight loss and ameliorate cardio-metabolic health in obese popula-tion: a systemic review. Am J Physiol Regul Integr Comp Physiol, 313:R251-R64.
51. Kayser B, Verges S (2013). Hypoxia, energy balance and obesity: from pathophysio-logical mechanisms to new treatment strategies. Obes Rev, 14:579-92.
52. Park HY, Lim K (2017). The effects of aer-obic exercise at hypoxic condition during 6 weeks on body composition, blood pressure, arterial stiffness, and blood lipid level in obese women. Int J Sports Sci Med, 1:1-5.
53. Wee J, Climstein M (2015). Hypoxic training: Clinical benefits on cardiometabolic risk factors. J Sci Med Sport, 18:56-61.
54. Heinonen IHA, Boushel R, Kalliokoski KK (2016). The circulatory and metabolic re-sponses to hypoxia in humans–with spe-cial reference to adipose tissue physiology and obesity. Front Endocrinol (Lausanne), 7:116.
55. Voss JD, Allison DB, Webber BJ, Otto JL, Clark LL (2014). Lower obesity rate dur-ing residence at high altitude among a military population with frequent migra-tion: a quasi experimental model for in-vestigating spatial causation. PLoS One, 9:e93493.
56. Boyer SJ, Blume FD (1984). Weight loss and changes in body composition at high alti-tude. J Appl Physiol Respir Environ Exerc Physiol, 57:1580–5.
57. Lippl FJ, Neubauer S, Schipfer S, et al (2010). Hypobaric hypoxia causes body weight reduction in obese subjects. Obesi-ty, 18:675–81.
58. Ri-Li G, Chase PJ, Witkowski S, et al (2003). Obesity: associations with acute mountain sickness. Ann Intern Med, 139:253–7.
59. Schobersberger W, Schmid P, Lechleitner M, et al (2003). Austrian Moderate Alti-tude Study 2000 (AMAS 2000). The ef-fects of moderate altitude (1,700 m) on cardiovascular and metabolic variables in patients with metabolic syndrome. Eur J Appl Physiol, 88:506–14.
60. Shukla V, Singh SN, Vats P, et al (2005). Ghrelin and leptin levels of sojourners and acclimatized lowlanders at high alti-tude. Nutr Neurosci, 8:161–5.
61. Westerterp KR, Kayser B, Wouters L, Le Trong JL, Richalet JP (1994). Energy bal-ance at high altitude of 6,542 m. J Appl Physiol, 77:862–6.
62. Westerterp-Plantenga MS, Westerterp KR, Rubbens M, et al (1999). Appetite at “high altitude” [Operation Everest III (Comex-’97)]: a simulated ascent of Mount Everest. J Appl Physiol, 87:391–9.
63. Yang B, Sun ZJ, Cao F, et al (2015). Obesity is a risk factor for acute mountain sick-ness: a prospective study in Tibet railway construction workers on Tibetan plateau. Eur Rev Med Pharmacol Sci, 19:119–22.
64. Kendzerska T, Leung RS, Gershon AS, Tomlinson G, Ayas N (2016). The inter-action of obesity and nocturnal hypox-emia on cardiovascular consequences in adults with suspected obstructive sleep apnea. A historical observational study. Ann Am Thorac Soc, 13:2234–41.
65. Park HY, Hwang H, Park J, Lee S, Lim K (2016). The effects of altitude/hypoxic training on oxygen delivery capacity of the blood and aerobic exercise capacity in elite athletes - a meta-analysis. J Exerc Nu-trition Biochem, 20:15-22.
66. Workman C, Basset FA (2012). Post-metabolic response to passive normobar-ic hypoxic exposure in sedendary over-weight males: a pilot study. Nutr Metab, 9:103.
67. Mekjavic IB, Amon M, Kölegård R, et al (2016). The effect of normobaric hypoxic confinement on metabolism, gut hor-mones, and body composition. Front Physiol, 7:202.
68. Gatterer H, Haacke S, Burtscher M, et al (2015). Normobaric intermittent hypoxia over 8 months does not reduce body weight and metabolic risk factors–a ran-domized, single blind, placebo-controlled study in normobaric hypoxia and nor-mobaric sham hypoxia. Obes Facts, 8: 200–9.
69. Kong Z, Zang Y, Hu Y (2014). Normobaric hypoxia training causes more weight loss than normoxia training after a 4-week residential camp for obese young adults. Sleep Breath, 18:591–7.
70. Morishima T, Kurihara T, Hamaoka T, Go-to K (2014). Whole body, regional fat ac-cumulation, and appetite-related hormo-nal response after hypoxic training. Clin Physiol Funct Imaging, 34:90–7.
71. Netzer NC, Chytra R, Küpper T (2008). Low intense physical exercise in normo-baric hypoxia leads to more weight loss in obese people than low intense physical exercise in normobaric sham hypoxia. Sleep Breath, 12:129–34.
72. Wiesner S, Haufe S, Engeli S, et al (2010). In-fluences of normobaric hypoxia training on physical fitness and metabolic risk markers in overweight to obese subjects. Obesity (Silver Spring), 18:116–20.
73. Calbet JA (2003). Chronic hypoxia increases blood pressure and noradrenaline spillo-ver in healthy humans. J Physiol, 551:379–86.
74. Kelly KR, Williamson DL, Fealy CE, et al (2010). Acute altitude-induced hypoxia suppresses plasma glucose and leptin in healthy humans. Metabolism, 59:200–5.
75. Verges S, Chacaroun S, Godin-Ribuot D, Baillieul S (2015). Hypoxic conditioning as a new therapeutic modality. Front Pediatr, 3:58.
76. Mackenzie R, Maxwell N, Castle P, et al (2011). Acute hypoxia and exercise im-prove insulin sensitivity (S(I) (2*)) in indi-viduals with type 2 diabetes. Diabetes Metab Res Rev, 27:94–101.
77. Fenkci S, Sarsan A, Rota S, Ardic F (2006). Effects of resistance or aerobic exercises on metabolic parameters in obese wom-en who are not on a diet. Adv Ther, 23:404–13.
78. Shatilo VB, Korkushko OV, Ischuk VA, Downey HF, Serebrovskaya TV (2008). Effects of intermittent hypoxia training on exercise performance, hemodynamics, and ventilation in healthy senior men. High Alt Med Biol, 9:43–52.
79. Haufe S, Wiesner S, Engeli S, Luft FC, Jor-dan J (2008). Influences of normobaric hypoxia training on metabolic risk mark-ers in human subjects. Med Sci Sports Ex-erc, 40:1939-44.
80. Millet GP, Debevec T, Brocherie F, Malates-ta D, Girard O (2016). Therapeutic use of exercising in hypoxia: promises and limi-tations. Front Physiol, 7:224.
How to Cite
PARK H-Y, JUNG W-S, KIM J, HWANG H, LIM K. Changes in the Paradigm of Traditional Exercise in Obesity Therapy and Application of a New Exercise Modality: A Narrative Review Article. Iran J Public Health. 48(8):1395-1404.
Review Article(s)