CHAPTER II

REVIEW OF RELATED LITERATURE

A literature review can be defined as the selection of available documents (both published and
untpublished) on the topic, which contain information, ideas, data and evidence written from a
particular standpoint to fulfil certain aims or express certain views on the nature of the topic and
how it is to be investigated, and the effective evaluation of these documents in relation to the
research being proposed (Hart, 1998). According to Bruce (1994) "Typically, the literature
review forms an important chapter in the thesis, where its purpose is to provide the background
to and justification for the research undertaken.” The purpose of the literature review is to locate
the research project, to form its context or background, and to provide insights into previous
work (Blaxter et al., 2006).

In this study, the different aspects of the overweight students such as selected components of
weight an fat related variables has been studied. In order to study these aspects thoroughly the
literature has been divided into four parts. In the first part studies related to aerobics related
research review, in second part studies related to Swiss ball and pilates exercise related research ,
in third part gymnastics effect to weight and fat component and in the third four part the studies
related to aquatics exercise effect to weight and fat related research have been covered.

REVIEW OF RELATED LITERATURE OF AEROBICS EXERCISE

REHABILITATION PROGRAM

Faigenbaum reported that the prevalence of obesity among children and adolescents is increasing
at an alarming rate. If current trends continue, this epidemic will likely pose an unprecedented
burden on youth, their families and our health care system. It is important to understand how
sensible lifestyle choices such as regular exercise can enhance the health and well-being of obese
children and adolescents. While aerobic exercise has traditionally been recommended for obese
youth, a growing body of scientific evidence indicates that resistance training can be a safe,
effective, and enjoyable method of exercise provided that appropriate training guidelines are
followed and qualified instruction is available. In addition to favourable changes in body
composition, regular participation in strength-building activities gives obese youth a chance to
experience success, feel good about their performances, and gain confidence in their abilities to
be physically active. Moreover, participation in resistance exercise gives youth with a high
percentage of body fat a chance to be exposed to a form of exercise that can be carried over into
adulthood. In this paper, we will discuss the potential benefits of resistance training for obese
youth and describe program design considerations for designing resistance training programs for
obese children and adolescents.

The prevalence of obesity during childhood and adolescence has reached epidemic proportions
worldwide.41, 52 This unabated epidemic is occurring in boys and girls across all socioeconomic
strata and it appears that obese children and adolescents are at high risk for becoming obese
adults.14, 27, 29, 31 These trends have led some observers to predict that the overall adult life
expectancy will decrease due to the increased prevalence of obesity-related co-morbidities such
as type 2 diabetes, cardiovascular disease and cancer.40 Today, childhood obesity, with its
associated co-morbid conditions and its likelihood of persistence into adulthood, is considered a
critical public health threat for the 21st century.29, 31 Learning how sensible lifestyle choices,
such as regular exercise, can improve the body composition and enhance the health and well-
being of obese children and adolescents is a growing area of interest among health and physical
education teachers, researchers, health care providers, and government officials. While both
normal weight and obese youth have traditionally been encouraged to participate in aerobic
activities such as walking and cycling, over the past two decades a compelling body of evidence
has accumulated to indicate that resistance training can be a safe, effective and beneficial method
of exercise for all youth regardless of body size.24, 38, 54 Research into the effects of resistance
exercise on normal weight and obese children and adolescents has increased over the years, and
the qualified acceptance of youth resistance training by medical and fitness organizations has
become almost universal.1, 3, 6, 16 This paper discusses the potential benefits of youth
resistance training and provides program design considerations for developing resistance training
programs for obese children and adolescents. For the purpose of this paper, the term “obese”
refers to youth (both children and adolescents) with a body mass index (BMI [weight in
kg/height in m2]) equal to or greater than the 95th percentile of the age- and gender-specific BMI
distribution.35 The term “at risk for obesity” is defined as a BMI at or above the age- and
gender-specific 85th percentile but less than the 95th percentile. The term “resistance training” is
defined as a specialized method of physical conditioning that involves the progressive use of a
wide range of resistive loads and a variety of training modalities to increase one’s ability to exert
or resist force. The term “children” refers to boys and girls who have not yet developed
secondary sex characteristics (approximately age 11 in girls and 13 in boys) and the term
“adolescence” refers to the period between childhood and adulthood and includes girls 12 to 18
years and boys 14 to 18 years.

Stasiulis examined that the objective of the study was to assess changes in body tion, blood lipid
and lipoprotein concentrations in 18-24-year-old women during the period of two-month aerobic
cycling training. Material and Methods: Young, healthy, nonsmoking women (n=19) volunteered
to participate in this study. They were divided in two groups: experimental (E, n=10) and control
(C, n=9). The subjects of group E exercised 3 times a week with intensity of the first ventilator
threshold and duration of 60 min. The group C did not exercise regularly over a two-month
period of the experiment. The subjects of group E were tested before and after 2, 4, 6 and 8
weeks of the experiment. The participants of group C were tested twice with an eight-week
interval. Results: Body weight, body mass index, body fat mass, and triacylglycerol (TAG)
concentration decreased and high-density lipoprotein cholesterol (HDL-ch) concentration
increased after the 8-week training program in the experimental group (P The two-month aerobic
cycling training (within VT1, 60-min duration, three times a week) may induce significant
changes in the parameters of body composition--body weight, body mass index, body fat mass,
and blood lipids--in young women. The following significant changes were observed: TAG level
decreased after 2 weeks, body mass and body mass index decreased after 6 weeks, body fat mass
decreased and HDL-ch level increased after 8 weeks. Peak oxygen uptake increased after 4
weeks.

Atlantis determined the overweight prevalence among children/adolescents is increasing, while

adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly
recommended, although treatment efficacy remains unclear. Objective: To determine the efficacy
of exercise alone for treating overweight in children/adolescents. Design: A systematic review
and meta-analysis of randomized trials published in English were completed following multiple
database searches performed on December 10, 2004. Studies of isolated or adjunctive
exercise/physical activity treatment in overweight/obese children or adolescents which reported
any overweight outcome were included. Literature searches identified 645 papers which were
manually searched, of which 45 were considered for inclusion, of which 13 papers which
reported 14 studies were included (N=481 overweight boys and girls, aged 12 years). Two
reviewers independently identified relevant papers for potential inclusion and assessed
methodological quality. Principal measures of effects included the mean difference (MD)
(between treatment and control groups), the weighted MD (WMD), and the standardized MD
(SMD). Results: Few studies were of robust design. The pooled SMD was -0.4 (-0.7, -0.1,
P=0.006) for percent body fat, and -0.2 (-0.6, 0.1, P=0.07) for central obesity outcomes, whereas
the pooled WMD was -2.7 kg (-6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favoured
exercise. Pooled effects on body weight were significant and larger for studies of higher doses,
whereas non significant and smaller effects were seen for studies of lower doses of exercise
(155–180 min/weeks vs 120–150 min/weeks) Conclusions: Based on the small number of short-
term randomized trials currently available, an aerobic exercise prescription of 155–180
min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight
children/adolescents, but effects on body weight

and central obesity are inconclusive. Recommendations for future study designs are discussed.

U. Narayani and R.L. Sudhan Paul Raj considered the aim of the present research was to
determine the effect of aerobic training on Percentage of Body Fat, total Cholesterol (TC) and
High Density Lipoprotein Cholesterol (HDL-C) amog obese women. For this purpose, 20 female
obese women (age17-25) were selected. The subjects received endurance training only one
session in the morning between 6-7 am for three alternate days a week for six weeks. To analyse
the collected data,'t'-ratio was used at 0.05 level of confidence. The results showed that there
were significant changes in Percentage of Body Fat, TC and HDL-

C. It was concluded that the aerobic training is widely believed to induce changes in the lipid
profiles and Percentage of Body Fat of women.

A. Sahranavard-Gargari nvestigation the aim of this was study the effect aerobic activity on body
fat percent in non-athlete girl students. So, among 50 non athlete volunteer students between 18-
25- years old, 20 Students who were all healthy selected. and their fat under-skin in these regions
were measured by Calliper and then with the use of table of estimating the fat percentage based
on age and the amount of under-skin fat in above mentioned three regions excerpted from Raven,
the fat percentage of the group was determine. Training consists of 45 minutes aerobic activity
(% 70- % 80 heart rate reserves) three times a week. Body fat percent were obtained before and
after the 8-week training period. The data was analysis using t-test and we used % 99 probability
levels for analysis. This study revealed that localized aerobic activities have been effectual in
reducing the fat percentage, and there is a significant difference between average fat percent of
objects of exercises group before and after exercises.

Diego Augusto Santos Silva et al examined the aim of this study was to evaluate the effect of an
aerobic physical exercise program without dietary intervention prescribed with blood lactate
levels on body composition and lipid profile of overweight adolescents. A randomized study
consisting of pre- and post-treatment tests was conducted on overweight adolescents who were
randomly divided into an experimental group submitted to an aerobic exercise program and a
control group. The exercise program lasted 12 weeks. After the intervention, a reduction in
triceps skin fold thickness, percent body fat and fat mass and an increase in fat-free mass and
lipid profile (HDL-c) were observed in the experimental group (p).

reported the research background: regular physical activity leads to significant changes in terms
of the reduction of health-related risks. Research question: The purpose of this study was to
investigate the effects of an eight-week step-aerobic dance exercise programme on weight loss
and body composition parameters in middle-aged

controlled trial. Methods: A total of 49 healthy sedentary obese women participated in this study
voluntarily. They were randomly divided into two groups: those undertaking a step-aerobic
dance exercise programme (n=29) and a control group (n=20). The subjects too part in a step-
aerobic dance exercise programme for one hour per day, three days a week for eight weeks. The
subjects' Body Mass Index (BMI), weight, waist circumference, waist-hip ratio, four-site skin
fold thickness, fat percentage, basal metabolic rate and lean body mass were assessed before and
after the completion of the step-aerobic dance exercise programme. Results: After the eight
weeks of the step-aerobic dance exercise programme, significant differences were found in the
subjects' weight, BMI, body composition parameters, waist-hip ratio (WHR), waist
circumference (WC), fat percentage, lean body mass (LBM) and basal metabolic rate (BMR) in
the experimental group (p0.05). Conclusion: The step aerobic dance programme proved to be a
useful exercise modality for weight loss and in terms of body composition. There was a clear
response to the eight-week step aerobic dance programme in terms of central obesity in sedentary
obese Turkish women.

Leslie H. Willis et al made a comparison the recent guidelines on exercise for weight loss and
weight maintenance include resistance training as part of the exercise prescription. Yet few
studies have compared the effects of similar amounts of aerobic and resistance training on body
mass and fat mass in overweight adults. STRRIDE AT/RT, a randomized trial, compared aerobic
training, resistance training, and a combination of the two to determine the optimal mode of
exercise for obesity reduction. Participants were 119 sedentary, overweight or obese adults who
were randomized to one of three 8-mo exercise protocols: 1) RT: resistance training, 2) AT:
aerobic training and 3) AT/RT: aerobic and resistance training (combination of AT and RT).
Primary outcomes included total body mass, fat mass and lean body mass. The AT and AT/RT
groups reduced total body mass and fat mass more than RT (P < 0.05), but they were not
different from each other. RT and AT/RT increased lean body mass more than AT (P < 0.05).
While requiring double the time commitment, a program of combined AT and RT did not result
in significantly more fat mass or body mass reductions over AT alone. Balancing time
commitments against health benefits, it appears that AT is the optimal mode of exercise for
reducing fat mass and body mass, while a program including RT is needed for increasing lean
mass in middle-aged, overweight/obese individuals.

Patricia CH Wong et al have pointed out that introduction: Developing effective exercise
programmes for the paediatric population is a strategy for decreasing obesity and is expected to
help in eventually limiting obesity-associated long-term health and societal impact. In this study,
the effects of a 12-week twice weekly additional exercise training, which comprised a
combination of circuit-based resistance training and aerobic exercises, in additional to typical
physical education sessions, on aerobic fitness, body composition and serum C-reactive protein
(CRP) and lipids were analyzed in 13- to 14-year-old obese boys contrasted with a control group.
Materials and Methods: Both the exercise group (EG, n = 12) and control group (CG, n = 12)
participated in the typical 2 sessions of 40-minute physical education (PE) per week in schools,
but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of
exercise training, which comprised a combination of circuit-based resistance training and aerobic
exercises maintained at 65% to 85% maximum

heart rate (HRmax = 220 - age). Body composition was measured using dual energy X-ray
absorptiometry (DEXA). Fasting serum CRP and blood lipids were analyzed pre- and post
exercise programme. Aerobic fitness was measured by an objective laboratory sub-maximal
exercise test, PWC170 (Predicted Work Capacity at HR 170 bpm). Results: Exercise training
significantly improved lean muscle mass, body mass index, fitness, resting HR, systolic blood
pressure and triglycerides in EG. Serum CRP concentrations were elevated at baseline in both
groups, but training did not result in a change in CRP levels. In the CG, body weight increased
significantly at the end of the 12-week period. Conclusion: This study supports the value of an
additional exercise training programme, beyond the typical twice weekly physical education
classes, to produce physiological benefits in the management of obesity in adolescents, including
prevention of weight gain.

Vivek G. Awasare examined the main purpose of the study was to see the effect of aerobics
exercises on physical fitness and body composition of school boys. The selected 40 student were
equally divided into two equal groups consisting 20 subjects in each group assigned in
experimental and control groups. The pre and post test were significantly different saw on
conducted on the physical fitness variables, abdominal strength, speed and cardiovascular
endurance and body composition.

Sofien Regaieg et al conducted the background: The prevalence of children obesity is raising
alarmingly in both developed and developing countries developing effective exercise programs
are a strategy for decreasing this prevalence and limiting obesity-associated long-term
comorbidities. Objectives: To determine whether 16-week training program; in addition to the
school physical education and without dietary intervention; could have beneficial effects on body
composition and aerobic capacity of obese children. Materials and Methods: Twenty-eight obese
children (16 boys, 12 girls; aged 12-14 years) were enrolled and were divided into either the
exercise group (EG, n = 14) or the control group (CG, n = 14). EG participated in a 16-week
aerobic exercises (four 60-min sessions per week at 70-85% of HRmax (maximum heart rate)),
in addition to the school physical education. Fat-Free Mass (FFM) and Fat Mass (FM) were
assessed with bioelectrical impedance equipment. To assess aerobic capacity, maximal metabolic
equivalent of task (MET-max) and maximal workload (W-max) were estimated with an
electronically braked cycle ergo meter (type Ergo line 500). Results: At baseline, there were no
differences between the two groups. After the training program, only the EG showed significant
reduction in BMI (body mass index) and waist circumference compared with the baseline values
(P < 0.001). Exercise training significantly decreased FM only in the EG. A significant increase
in FFM was seen in both groups; more marked in the EG. There was a significant increase in
MET-max (P <

0.05) and W-max (P = 0.02) in the EG, and no significant changes in these parameters were seen
in the CG. HRmax significantly decreased only in the EG (P < 0.05). Conclusion: This training
program has beneficial effects on body composition and aerobic capacity parameters in obese
children. Our intervention has the advantage of providing a sustainable and reproducible school
and community approach for the management of children obesity.

The purpose of this study was to determine the effect of 14 weeks of high intensity versus
moderate intensity aerobic exercise of equal work output on body composition in overweight
men (BMI = 25-29.9 kg/m2). Sixteen sedentary military men (18 - 33 yrs) were randomized in
two equal groups (n=8): 1) moderate intensity exercise (MI; 60 - 70% of their maximum heart
rate; HRmax), and 2) high intensity exercise (HI; 75 - 90% HRmax) The aerobic exercise
(jogging/running) training program was performed three days/wk. Relative body fat (% BF) was
assessed by dual energy x-ray absorptiometry (DXA) (Lunar DPX - IQ). Significant differences
between and within the groups were analyzed using a two-way split-plot analysis of variance
(SPANOVA). Statistical significance was accepted at p0.05). It is concluded that 14 wks of HI
aerobic exercise may be more effective in improving body composition than MI aerobic exercise
in overweight young military men with physical characteristics similar to the present study.
Pantelic Sasa et al. nvestigation the aim of this study was to determine the effects of a twelve-
week aerobic dance-training program on the body composition parameters of young women. The
sample of 59 young women belonged to one of two groups, an experimental (EXP) or a control
(CON) group. The experimental group consisted of 29

assess body compositions, the following measures were used: the overall sum of the upper body
skin folds, the overall sum of the lower body skin folds, the overall sum of skin folds of the
upper and lower body, the percentage of body fat, the percentage of muscle mass in the body,
body height and body weight. For all of the sums of skin folds for the subjects of the EXP group,
we noted a statistically significant decrease (p< 0.05) at the final measuring in relation to the
initial measuring (SFUPPER - 39.35 mm compared to 42.87 mm; SFLOWER -

39.35mm compared to 49.88 mm; TOTAL SF - 76.97 mm compared to 92.75 mm). In the case
of BF%, a decrease was noted at the final measuring in relation to the initial one (20.37%
compared to 22.66%), which was statistically significant (p< 0.05). On the basis of our results,
we can conclude that aerobic dance decreases subcutaneous fatty tissue and body composition of
the young women.

Sohaily Shahram

examined the Obesity increases the risk of various diseases. Leptin and insulin are hormones that
are involved in regulating and balancing body weight and obesity. This research aims to explore
the impact of intermittent exercise on serum concentration of leptin and insulin resistance in
overweight female students. For this purpose, 30 female overweight volunteer students (BMI ≥
26) of Azad University Parand Campus were selected and randomly divided into two groups:
intermittent training group and control group. Training groups exercised for 12 weeks, three
sessions a week with definite intensity and distance. Leptin, insulin, glucose, body weight, fat
percentage, BMI And maximum oxygen consumption were measured both before and after the
12-week exercise. Using Independent T-test, the results showed that interval training had
significant effect on leptin, insulin resistance index, body weight, fat percentage, BMI and
maximum oxygen consumption (p ≤ 0.05). Therefore our findings support the hypothesis that
intermittent exercise leads to significant decrease of leptin levels and insulin resistance.
Song J K Reported that the Aim: This study tested the hypothesis that 12 weeks of air board
exercise would enhance cardio respiratory fitness and vascular compliance and reduce % body
fat in obese Korean boys. Methods: Twenty-two obese boys (>30% body fat) were studied. They
were divided into 2 groups- an aerobic exercise group (N.=12), which trained 3 days/week, 50
min/day for 12 weeks, and a control group (N.=10). Control subjects only performed activities
involved in their physical education classes. Body composition, cardiovascular fitness (20 m
multistage endurance test performance) and vascular compliance were assessed before and after
the completion of exercise training. Results: The % changes in body fat (-4.6±0.9 vs. -
1.5±1.0%), fat mass (-5.4±1.5 vs. -0.1±1.6%) and performance on the cardiovascular fitness test
(14.3±2.5 vs. 3.7±1.6%) were greater in the exercise group than in the controls Compared to
controls, % increases in vascular compliance were greater in the arms and legs of the exercise
group (left arm: 2.8±0.5 vs. 2.0±2.9%; left leg: 2.6±1.2 vs. -

0.5±2.0%; right arm: 2.9±0.9 vs. 0.3±2.9%; right leg: 4.8±1.8 vs. 1.5±2.0%). Conclusion:
Results suggest that exercise training can reduce % body fat and enhance vascular compliance in
obese male adolescents; changes that may reduce the risk for later development of cardiovascular
disease.