Journal of Endocrinological Investigation

, Volume 42, Issue 12, pp 1497–1507 | Cite as

One-year caloric restriction and 12-week exercise training intervention in obese adults with type 2 diabetes: emphasis on metabolic control and resting metabolic rate

  • F. Zurlo
  • C. TrevisanEmail author
  • N. Vitturi
  • E. Ravussin
  • C. Salvò
  • S. Carraro
  • M. Siffi
  • I. Iob
  • A. Saller
  • L. Previato
  • G. Sergi
  • S. de Kreutzenberg
  • A. Maran
  • A. Avogaro
Original Article



The effect of combined lifestyle interventions (LSI) including dietary and physical activity on metabolic health, energy metabolism and VO2max in diabetic patients has provided mixed results. We evaluated the impact of 1-year caloric restriction (CR), and 12-week supervised structured exercise training (SSET) on metabolic health, RMR and VO2max in obese adults with type 2 diabetes.


After 1-month education for LSI, 33 participants had anthropometric, biochemical and metabolic assessments. They then started CR based on RMR, and 3-month SSET during the months 1–3 (Early-SSET) or 4–6 (Late-SSET). Reassessments were planned after 3, 6 and 12 months. Using a per-protocol analysis, we evaluated parameter changes from baseline and their associations for the 23 participants (11 Early-SSET, 12 Late-SSET) who completed the study. RMR was adjusted (adjRMR) for age, sex, fat-free mass (FFM) and fat mass (FM).


Compared with baseline, after 6 months we found significant increases in VO2max (+ 14%) and HDL-cholesterol (+ 13%), and reduction in body mass index (− 3%), FM (− 8%) and glycated hemoglobin (HbA1c, − 7%). Training-related caloric expenditure negatively correlated with changes in body weight (p < 0.001), FM (p < 0.001) and HbA1c (p = 0.006). These results were confirmed at the 12-month follow-up. Pooling together all follow-up data, adjRMR changes correlated with changes in glycemia (r = 0.29, p = 0.02), total-cholesterol (r = 0.29, p = 0.02) and VO2max (r = − 0.26,p = 0.02). No significant differences emerged between the Early- and Late-SSET groups.


Combined intervention with SSET and CR improved metabolic control. Changes in metabolic health and fitness correlated with changes of adjRMR, which was reduced improving fitness, glycemia and cholesterolemia.

Clinical trial registry

Trial registration number: NCT03785379. URL of registration:


Caloric restriction diet Obesity Resting metabolic rate Structured exercise Type 2 diabetes 



The authors are indebted to the nursing staff and physicians of the Diabetes Clinic, and to the laboratory staff of the Department of Medicine, Metabolic Unit for their assistance; to Prof. E. Manzato, chief of the Department of Medicine, Geriatrics Division, for the use of the calorimetric and body composition equipment; to Mrs. E. Rampazzo and the staff of Forum Wellness Club; to Mr. P. Servidei for the computer assistance; to Ms. M. Adams for editing the manuscript; and to Prof. Egle Perissinotto for the statistical support. Finally, we are especially grateful to all of the volunteer participants whose commitment made this study possible.

Author contributions

FZ, AA, ER, and GS contributed to the study concept and design. FZ and CT contributed to the statistical analysis. FZ, CT, MS, CS, NV, SC, II, AS, LP, SdK, and AM, contributed to the data collection. FZ, CT, ER, NV, and GS contributed to the drafting of the manuscript. All authors contributed to the interpretation of the results and approved the final version of the manuscript. FZ is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors disclose no potential conflicts of interest.

Ethical approval

The research conforms to the principles of the Declaration of Helsinki, revised in 2000. The Ethics Committee of the University Hospital of Padua approved the protocol (Prot. n. 2718P).

Informed consent

Written informed consent was obtained from all patients.

Supplementary material

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Supplementary material 1 (DOCX 351 kb)
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Supplementary material 2 (DOCX 376 kb)
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Supplementary material 3 (DOCX 167 kb)
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Supplementary material 4 (DOCX 22 kb)


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • F. Zurlo
    • 1
  • C. Trevisan
    • 2
    Email author
  • N. Vitturi
    • 1
  • E. Ravussin
    • 3
  • C. Salvò
    • 1
  • S. Carraro
    • 2
  • M. Siffi
    • 4
  • I. Iob
    • 1
  • A. Saller
    • 5
  • L. Previato
    • 5
  • G. Sergi
    • 2
  • S. de Kreutzenberg
    • 1
  • A. Maran
    • 1
  • A. Avogaro
    • 1
  1. 1.Metabolic Unit, Department of MedicineUniversity of PaduaPaduaItaly
  2. 2.Geriatrics Division, Department of MedicineUniversity of PaduaPaduaItaly
  3. 3.Division of Clinical Sciences PenningtonBiomedical Research CenterBaton RougeUSA
  4. 4.Forum Wellness ClubPaduaItaly
  5. 5.Department of Medicine, Clinica Medica 1University of PaduaPaduaItaly

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