Effects of caloric restriction with different doses of exercise on fat loss in people living with type 2 diabetes: A secondary analysis of the DOSE-EX randomized clinical trial

• In people living with newly diagnosed type 2 diabetes mellitus and overweight/obesity, adding caloric restriction with—or without exercise reduced fat mass, and body weight, and improved overall body composition. • Adding exercise to caloric restriction reduced fat mass—and preserved fat-free mass dose-dependently. • Adding exercise to caloric restriction may augment the therapeutic effects of dietary weight loss treatments by facilitating a reduction in fat mass and preservation of fat-free mass as compared to caloric restriction alone. Fat loss mainly conveys the benefits of caloric restriction for people living with type 2 diabetes. The literature is equivocal regarding whether exercise facilitates fat loss during caloric restriction. This analysis aimed to assess the dose–response effects of exercise in combination with a caloric restriction on fat mass (FM) and FM percentage (FM%) in persons with diagnosed type 2 diabetes. In this secondary analysis of a 4-armed randomized trial, 82 persons living with type 2 diabetes were randomly allocated to the control group (CON) ( n = 21), diet control (DCON) (25% caloric restriction; n = 20), diet control and exercise 3 times per week (MED) (n = 20), or diet control and exercise 6 times per week (HED) ( n = 21) for 16 weeks. The primary analysis was the change in FM% points. Secondary analyses included fat-free mass and visceral adipose tissue (VAT) volume (cm 3 ). FM% decreased compared to CON by a mean difference of –3.5% (95% confidence interval (95%CI): –5.6% to –1.4%), –6.3% (95%CI: –8.4% to –4.1%), and –8.0% (95%CI: –10.2% to –5.8%) for DCON, MED, and HED, respectively. Compared to DCON, MED, and HED decreased FM% by –2.8% (95%CI: –4.9% to –0.7%) and –4.5% (95%CI: –6.6% to –2.4%), respectively. The difference in FM% between HED and MED was –1.8% (95%CI: –3.9% to 0.4%). DCON and MED decreased fat-free mass compared to CON, whereas HED preserved fat-free mass (–0.2%; 95%CI: –2.0% to 1.7%). Compared to CON, VAT volume decreased by –666.0 cm 3 (95%CI: –912.8 cm 3 to –385.1 cm 3 ), –1264.0 cm 3 (95%CI: –1679.6 cm 3 to –655.9 cm 3 ), and –1786.4 cm 3 (95%CI: –2264.6 cm 3 to –1321.2 cm 3 ) more for DCON, MED, and HED, respectively. HED decreased VAT volume more than DCON (–1120.4 cm 3 ; 95%CI: –1746.6 cm 3 to –639.4 cm 3 ) while the remaining comparisons did not reveal any differences. All interventions were superior in reducing FM% compared to standard care. Adding exercise to a caloric restriction was superior in reducing FM% compared to a caloric restriction alone.

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