• Eli Maria Pazzianotto-Forti, Marlene Aparecida Moreno, Emma Plater, Silvia Beatriz Serra Baruki, Irineu Rasera-Junior, and W Darlene Reid.
• Faculty of Health Sciences, Methodist University of Piracicaba, Rodovia do Açucar, Km 156, Piracicaba, Sao Paulo 13.400-911, Brazil.
• Phys Ther. 2020 Jun 23; 100 (6): 963-978.

BackgroundPhysical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease.PurposeThe purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity.Data SourcesMedline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017.Study SelectionThis review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article.Data ExtractionThree reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached.Data SynthesisOf the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias.LimitationsThe large variability of outcomes and interventions made comparisons difficult.ConclusionsA combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.© 2020 American Physical Therapy Association.

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