Effects of Aerobic Exercise Training in Hypoxia versus Normoxia on Body Composition and Metabolic Health in Overweight and/or Obese Population: An updated Meta-Analysis

Effects of Aerobic Exercise Training in Hypoxia versus Normoxia on Body Composition and Metabolic Health in Overweight and/or Obese Population: An updated Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Aerobic Exercise Training in Hypoxia versus Normoxia on Body Composition and Metabolic Health in Overweight and/or Obese Population: An updated Meta-Analysis Li Ding, Jin Huang, Jue Liu, Li Guo, Bin Chen, Yinhang Cao, Olivier Girard This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5556421/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Oct, 2025 Read the published version in Sports Medicine-Open → Version 1 posted 5 You are reading this latest preprint version Abstract Background While aerobic training is well-established for improving body composition and metabolic health in normoxia, its effectiveness in hypoxia remains unclear. Objective This meta-analysis examines whether aerobic training in hypoxia is more effective than in normoxia for improving body composition and metabolic health in overweight and/or obese individuals, and identifies optimal exercise prescription variables. Methods A search of five databases was conducted through 10 November 2024. Random-effects meta-analyses evaluated body composition (e.g., body mass and fat mass) and metabolic health markers (e.g., triglycerides and glucose). Subgroup analyses were performed based on inspired oxygen fraction (FiO 2 ), exercise duration, frequency, session length, and age. Results Aerobic training in hypoxia resulted in greater reductions in body mass (mean difference [MD] = -0.90, 95% confidence interval [CI]: -1.80 to -0.01), triglycerides (MD = -10.78, 95% CI: -20.68 to -0.88), low-density lipoprotein cholesterol (MD = -5.28, 95% CI: -8.75 to -1.81), and insulin resistance (MD = -0.22, 95% CI: -0.33 to -0.11) (all p < 0.05), with a trend towards larger fat mass loss (MD = -1.22, 95% CI: -2.59 to 0.15, p = 0.08). These benefits were more prominent in moderate hypoxia (FiO 2 ≥ 15%), in individuals < 40 years, and with protocols involving ≥ 4 days/week, ≥ 60-min sessions, and < 8 weeks of training. Conclusion Aerobic training in hypoxia is more effective than in normoxia for reducing body mass, fat mass, triglycerides, low-density lipoprotein cholesterol, and insulin resistance in overweight and/or obese individuals. These findings could help inform obesity management strategies using hypoxic training. aerobic training hypoxia body composition metabolic health obesity Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Key points Aerobic exercise training in hypoxia led to larger reductions in body mass, fat body mass, triglycerides, and low-density lipoprotein cholesterol in overweight and/or obese individuals. Moderate hypoxia protocols (FiO 2 ≥ 15%) with sessions lasting ≥ 60 min, ≥ 4 days/week, and < 8 weeks of training were effective in managing obesity, particularly in individuals aged < 40 years. 1. Introduction Aerobic exercise, defined as the rhythmic movement of the body's large muscles for at least 10 min [ 1 ], is a well-established strategy for obesity management [ 2 ], improving metabolism and supporting healthy body composition [ 3 , 4 ]. The World Health Organization recommends moderate-to-high intensity aerobic exercise as an effective intervention for weight loss in individuals with obesity [ 2 , 5 ]. However, higher intensity exercises may be less enjoyable and harder to due to the greater body mass of overweight and obese individuals [ 6 ]. Additionally, such exercises can increase the risk of musculoskeletal injuries, potentially undermining weight loss efforts [ 7 – 9 ]. Consequently, it is imperative to develop safe, well-tolerated, and effective aerobic exercise strategies tailored to the specific needs of this population. In recent years, exercise training in low oxygen conditions (hypoxia) has emerged as a promising intervention for obesity management [ 10 – 12 ]. For instance, studies have compared aerobic exercise training (50–60 min of running, 3 days/week for 4 weeks at 60–65% of maximal oxygen uptake [V̇O 2max ]) in normoxia and hypoxia (inspired oxygen fraction [FiO 2 ] = 15%) [ 13 , 14]. These studies found that hypoxic training leads to greater improvements in body composition (e.g., body mass index [BMI], fat body mass [FBM], and waist circumference) and metabolic markers (e.g., blood glucose, insulin, total cholesterol, and triglycerides [TG]) at lower absolute exercise intensities[ 13 , 14]. These benefits are thought to result from hypoxia’s potential to boost glucose uptake and transport [ 15 ], fat oxidation [ 16 ], and appetite regulation through the activation of hypoxia-inducible factors (HIF) [ 17 ], ultimately improving health markers [16]. Several meta-analyses have compared the effects of exercise training on body composition and metabolism between hypoxia and normoxia [ 18 – 21 ], but the results remain inconsistent. Some meta-analyses reported larger reductions in TG [ 21 ], FBM and BMI [ 20 ] following hypoxic compared to normoxic training, while others found no significant differences between conditions [ 18 , 19 ]. However, these meta-analyses present several limitations: (a) the inclusion of other exercise modalities, such as resistance training and high-intensity interval training [ 18 – 21 ], which are less effective for fat loss in obese populations compared to aerobic exercise [ 3 , 4 , 22 ], potentially reducing the effects of hypoxic interventions; (b) the lack of subgroup analyses for accounting for variables like hypoxic dose (e.g., severity), exercise intervention (e.g., duration, frequency), and population characteristics (e.g., age), leading to substantial heterogeneity ( I² > 50%) [ 19 – 21 ]. Since our previous meta-analysis on the effects of hypoxic exposure on fat loss and cardiometabolic markers [ 21 ], several new randomized controlled trials have been published [ 23 – 25 ], highlighting the need for an updated meta-analysis that incorporates more comprehensive data. The purpose of this meta-analysis was to evaluate the efficacy of aerobic exercise training on body composition and metabolic health in overweight and/or obese individuals, comparing the effects of hypoxia and normoxia. Additionally, we explored factors that may influence these outcomes and provide practical recommendations to optimize hypoxic training interventions. 2. Methods This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [ 26 ] and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024577543). 2.1 Literature search We searched five databases (PubMed, Web of Science, EMBASE, Scopus, and CNKI) from their inception to 10 November 2024. The search used specific terms and Boolean operators ('AND,' 'OR,' 'NOT'): “hypoxia”, “altitude”, “hypoxic”, “exercise”, “aerobic”, “body composition”, “FBM”, “lean mass”, “muscle mass”, “fat-free mass”, “weight loss”, “fat loss”, “metabolism”, “metabolic” “overweight”, “obesity”, “obese”. When necessary, we contacted authors via email to request missing data and conducted manual searches using Google Scholar to ensure comprehensive coverage of relevant literature. 2.2 Selection criteria Each study included was required to meet the following the criteria based on the participants, interventions, comparators, outcomes, and study design (PICOS) framework: (1) participants were overweight (body mass index [BMI] ≥ 25 kg/m 2 ) and/or obese (BMI ≥ 30 kg/m 2 ), without physical activity restrictions or severe diseases that could impede exercise interventions; (2) the intervention involved aerobic exercise training in hypoxia (simulated altitude ≥ 2000 m or FiO 2 ≤ 16.5%) at least 2 days/week with moderate-to-high intensity (≥ 45% V̇O 2max or ≥ 50% heart rate reserve [HHR] or ≥ 60% maximum heart rate [HR max ]) [ 21 , 27]; (3) an equivalent aerobic exercise training protocol in normoxia was used as a comparator; (4) outcomes related to body composition (body mass [BM], BMI, lean body mass [LBM], FBM, waist circumference [WC], hip circumference [HC], waist-to-hip ratio [WHR]) and metabolic health (total cholesterol [TC], TG, low-density lipoprotein [LDL], high-density lipoprotein [HDL], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], glucose, insulin, and homeostasis model assessment index of insulin resistance [HOMA-IR]) were reported; (5) the study design utilized a randomized controlled trial. Studies were excluded based on the following criteria: (1) participants had severe diseases that could hinder exercise interventions (e.g., cardiovascular diseases or type 2 diabetes); (2) the intervention combined aerobic exercise with other types of training (e.g., interval training, resistance training, or whole-body vibration); (3) blood flow restriction was used as the hypoxic intervention; (4) full-text articles or data extraction was unavailable; (5) the study was a conference abstract, review, case report, or animal experiment; (6) the study was not published in English or Chinese. 2.3 Study selection The retrieved literature was imported into EndNote (Version X9, Clarivate Analytics, Philadelphia, USA) reference management software, and duplicates were removed. During the initial screening, two independent investigators (H.J. and D.L.) reviewed the titles and abstracts of all studies to identify potentially relevant ones. Full-texts of the relevant studies were then obtained and assessed for compliance with the inclusion and exclusion criteria. Any disagreements between the two investigators were resolved through consultation with a third investigator (C.Y.), who helped finalize the list of included studies. 2.4 Data extraction Two independent investigators (H.J. and D.L.) extracted relevant data from the eligible studies, including: (1) basic information (author [s], year of publication and title); (2) participant characteristics (sample size, age, sex, and BMI); (3) hypoxic exposure (hypoxia severity, duration, and pattern); (4) exercise protocol (duration, frequency, and session length); (5) outcome indicators (mean value, standard deviation [SD], and sample size). If studies did not report the mean values and SD of the differences before and after the intervention, these were calculated using the following formula [ 28 ]: $$\:Mean={Mean}_{after}-{Mean}_{before}$$ $$\:SD=\:\sqrt{{SD}_{before}^{2}+{SD}_{after}^{2}-2\times\:Corr\times\:{SD}_{before}\times\:{SD}_{after}}$$ where Mean before and Mean after represent the means of the pre-intervention and post-intervention, respectively. SD before and SD after represent the SDs of the pre-intervention and post-intervention, respectively. Corr is the correlation coefficient between the hypoxic and normoxia groups, often assumed to be 0.5 when no correlation is reported [ 28 ]. 2.5 Assessment of methodological quality The methodological quality and risk of bias of all included studies were assessed following the Cochrane guidelines [ 29 ]. The Cochrane risk of bias assessment tool examines studies across several domains: (1) random sequence generation; (2) allocation concealment; (3) blinding of participants and personnel; (4) blinding of outcome assessment; (5) incomplete outcome data; (6) selective reporting; and (7) other potential sources of bias. Each domain was rated as 'low risk' ('+'), 'high risk' ('-'), or 'unclear risk' ('?'). Two independent investigators (D.L. and H.J.) carried out the assessments using Review Manager software (Version 5.4, the Cochrane Collaboration, Oxford, UK). Any discrepancies in the risk of bias ratings were resolved through discussion and, when necessary, by involving a third reviewer (C.Y.). 2.5 Statistical analysis Data analysis was performed using Review Manager software (version 5.4, The Cochrane Collaboration, Oxford, UK) and Stata software (version 14, Stata Corp, TX, USA). After standardizing the extracted variables to consistent units, a random-effects model was applied to assess the differences in outcomes between hypoxic and normoxic interventions. Results were reported as mean differences (MD), 95% confidence intervals (CI), and p -values [ 4 , 30 ]. Study heterogeneity was quantified using the I² statistic, classified as low ( I² 50%) [ 31 ]. Publication bias was assessed via funnel plots, along with Begg's and Egger's tests. Statistical significance was set at p < 0.05. In line with prior research [ 18 – 21 , 32 ], subgroup analyses were conducted to examine the effect of potential factors: (1) age (< 40 years vs. ≥ 40 years); (2) hypoxia severity (FiO 2 < 15% vs. ≥ 15%); (3) frequency (< 4 days/week and ≥ 4 days/week); (4) training duration ( 60 min). 3 Results 3.1. Search results A total of 5267 studies were identified from the databases. After removing 2488 duplicates, 2779 studies were excluded based on titles and abstracts. Fifty-one studies underwent full-text screening, and 13 studies met the inclusion criteria and were included in the analysis [13, 14, 23-25, 33-40] (Figure 1). ---------------------------insert Figure 1 about here------------------------------ 3.2. Study characteristics A total of 14 trials from 13 studies (one study was included twice due to two groups with different hypoxia severities) were analyzed quantitatively (Table 1). The total number of participants across the 14 trials was 346 (hypoxia: 176; normoxia: 170). Participants’ ages ranged from 18 to 57 years, and BMIs between 25.1 and 37.9 kg/m 2 . The duration of the aerobic exercise training interventions varied between 3 and 32 weeks, with session lengths ranging from 20 to 90 min, frequencies from 2 to 5 days/week, and intensities from 60% to 75% V̇O 2max or 60% to 75% HR max . In the hypoxia groups, FiO 2 ranged from 13.0% to 16.5%. ---------------------------insert Table 1 about here------------------------------ 3.3. Quality of study methods Risk of bias was evaluated for the 13 included studies. One study was rated as high risk due to incomplete outcome data, while the remaining 12 studies were considered moderate risk (Figure 2). The funnel plot indicated slight asymmetry, suggesting possible publication bias (Figure 3). Since funnel plots are subjective, further objective evaluation was performed using Begg's and Egger's tests. Most major outcomes showed p -values greater than 0.05, except for LDL ( p = 0.04), indicating no significant publication bias for these outcomes (tests for WHR were not conducted due to fewer than three studies) (Table 2). ---------------------------insert Figure 2 and 3 about here------------------------ ---------------------------insert Table 2 and 3 about here------------------------- 3.4 Meta-analysis results Body composition The meta-analysis summary on body composition indicators is shown in Table 2. Compared to normoxia, aerobic exercise training in hypoxia showed larger reduction in BM (MD = -0.90, 95% CI: -1.80 to -0.01, p < 0.05, I 2 = 0%, Figure 4) and a favorable trend towards larger FBM loss (MD = -1.22, 95% CI: -2.59 to 0.15, p = 0.08, I 2 = 0%, Figure 5) in overweight and/or obese populations. However, no significant differences were observed between hypoxia and normoxia for BMI, LBM, WC, HC, and WHR (all p > 0.05) (Table 2). ---------------------------insert Figure 4 and 5 about here------------------------ The summary of the subgroup analysis is shown in Table 3. Aerobic exercise training in hypoxia resulted in greater BM loss compared to normoxia for session lengths of ≥ 60 min (MD = −0.89, 95% CI: -1.80 to -0.01, p = 0.05, I² = 0%), but not for session lengths of < 60 min (MD = -1.25, 95% CI: -7.55 to 5.06, p = 0.70, I² = 0%). A favorable trend towards greater BM loss in hypoxia was also noted at FiO₂ ≥ 15% (MD = -0.85, 95% CI: -1.77 to 0.06, p = 0.07, I² = 0%), but not at FiO₂ < 15% (MD = -2.00, 95% CI: -6.29 to 2.30, p = 0.36, I² = 0%). Furthermore, hypoxia led to larger reductions in FBM with a frequency of ≥ 4 days/week (MD = -1.78, 95% CI: -3.46 to -0.01, p < 0.05, I² = 0%) and in participants aged < 40 years (MD = -1.84, 95% CI: -3.66 to -0.02, p = 0.05, I² = 0%), but not with a frequency of < 4 days/week (MD = -0.09, 95% CI: -2.47 to 2.30, p = 0.95, I² = 0%) or in participants aged ≥ 40 years (MD = -0.43, 95% CI: -2.50 to 1.64, p = 0.69, I² = 0%) (Table 3). Metabolic health The meta-analysis summary on metabolic health indicators is displayed in Table 2. Compared to normoxia, aerobic exercise training in hypoxia lead to larger reductions in TG (MD = -10.78, 95% CI: -20.68 to 0.88, p = 0.05, I 2 = 0%, Figure 6), LDL-C (MD = -5.28, 95% CI: -8.75 to -1.81, p < 0.05, I 2 = 0%, Figure 7), and HOMA-IR (MD = -0.22, 95% CI: -0.33 to -0.11, p 0.05) (Table 2). ---------------------------insert Figure 6-8 about here------------------------ The results of the subgroup analysis are presented in Table 3. Larger reductions in TG were reported after aerobic exercise training in hypoxia compared to normoxia in subgroups with a duration of < 8 weeks (MD = -11.78, 95% CI: -22.16 to -1.40, p < 0.05, I² = 0%), session length of ≥ 60 min (MD = -10.80, 95% CI: -20.85 to 0.70, p = 0.05, I² = 0%), FiO₂ ≥ 15% (MD = -12.75, 95% CI: -23.02 to -2.49, p 0.05) (Table 4). For LDL-C, aerobic exercise training in hypoxia induced larger effects than normoxia in subgroups with a frequency of ≥ 4 days/week (MD = -5.28, 95% CI: -8.75 to -1.82, p < 0.05, I² = 0%), FiO₂ ≥ 15% (MD = -5.34, 95% CI: -8.88 to -1.79, p < 0.05, I² = 0%), and age < 40 years (MD = -5.47, 95% CI: -9.01 to -1.92, p < 0.05, I² = 0%). No significant differences were reported in the other subgroups (Table 3). 4 Discussion This meta-analysis is the first to compare the independent (not combined with other exercise forms) effects of aerobic exercise training interventions in hypoxia versus normoxia on body composition and metabolic health in overweight and/or obese individuals. Our results indicate that training in hypoxia is more effective than in normoxia for reducing BM, FBM, TG, LDL-C and HOMA-IR. These findings highlight the benefits of aerobic exercise training in hypoxia, supporting its potential as an effective intervention for obesity management. 4.1 Body composition outcomes Our results indicate that aerobic exercise training in hypoxia leads to a greater reduction in BM compared to normoxia in overweight and/or obese individuals (Fig. 4 ). Typically, BM loss results from reductions in FBM, LBM, or both [ 41 ]. Given the similar benefits observed on LBM ( p = 0.71) and other body composition indicators (BMI, LBM, WC, HC, WHR, p = 0.15–0.92) between the two conditions (Table 2 ), it can be speculated that the larger BM reduction is primarily due to a trend towards larger FBM loss ( p = 0.08). This is consistent with a meta-analysis by He et al. [ 20 ], which demonstrated that exercise training in hypoxia more effectively reduces FBM than in normoxia in middle-aged and older adults. Several physiological mechanisms may explain the enhanced fat loss with hypoxic aerobic exercise. First, aerobic exercise training in hypoxia may increase metabolic rate and energy expenditure by stimulating GLUT-4 glucose transport and enhancing mitochondrial quantity and efficiency [ 42 – 44 ], which may reduce fat accumulation. Second, hypoxic exposure may stimulate leptin secretion while lowering acylated ghrelin levels [ 45 , 46 ], thereby suppressing appetite and reducing calorie intake. The reduction in calorie intake contributes to a larger energy deficit, which is critical for effective obesity management [ 47 ]. Third, the synergistic effects of hypoxic exposure and exercise may enhance post-exercise fat oxidation, leading to greater FBM loss compared to normoxia [ 48 ]. A previous meta-analysis that included various exercise modalities (e.g., resistance, high-intensity interval, and aerobic exercise) showed no greater reduction in FBM with hypoxic exercise compared to normoxia in overweight and/or obese individuals [ 19 ]. The discrepancy between their results and ours regarding FBM loss may stem from differences in the types of exercise modalities included (a combination of aerobic exercise, resistance exercise, and high-intensity interval training in [ 19 ] vs. aerobic exercise only in the present study). Recent studies suggest that aerobic exercise is more effective than resistance exercise and high-intensity interval training for reducing FBM in overweight and/or obese populations [ 3 , 4 , 22 ]. While high-intensity interval training and resistance exercise primarily promote hormone secretion (e.g., catecholamines and growth hormone) and increase LBM [ 49 , 50 ], aerobic exercise mainly targets fat mass reduction [ 50 ]. However, there is currently no direct evidence comparing the effects of different exercise modalities on FBM reduction in hypoxia, which warrants further research. Our subgroup analysis showed that, compared to normoxia, aerobic exercise training in hypoxia led to a greater reduction in FBM for individuals aged < 40 years, while no such effect was observed in those aged ≥ 40 years (Table 3 ). However, a meta-analysis by Ramos-Campo et al. [ 18 ], which included various exercise modalities, failed to report larger reduction in FBM with hypoxic exercise training over normoxia in overweight and/or obese individuals aged 14–57 years. In addition to the influence of mixed exercise types discussed earlier, these divergent findings may also stem from the confounding factor of age. In their meta-analysis, approximately half of the participants were over 40 years old [ 18 ]. Research has demonstrated that aging is associated with a decline in both daily physical activity and basal metabolic rate [ 20 , 51 ], which may reduce energy expenditure and limit the effectiveness of hypoxic exercise interventions. Overall, compared to normoxia, aerobic exercise training in hypoxia results in larger reductions in FBM and BM in overweight and/or obese individuals, particularly those aged < 40 years, suggesting its potential for improving body composition. 4.2 Metabolic health outcomes Aerobic exercise training in hypoxia resulted in a greater reduction in TG compared to normoxia in overweight and/or obese individuals (Fig. 6 – 7 ). This is consistent with a previous meta-analysis, which found that hypoxic exercise training led to a greater decrease in TG in this population [ 21 ]. We also observed a larger reduction in LDL-C following aerobic exercise training in hypoxia. These findings further support previous research suggesting that hypoxic aerobic exercise can alleviate dyslipidemia and maintain lipid metabolic health [ 13 , 14 ]. Among all the studies included in our meta-analysis, the only difference between the normoxia and hypoxia groups was exposure to a hypoxic environment during exercise. Consequently, the observed improvements in lipid metabolism can be predominantly attributed to hypoxic exposure. The underlying mechanisms are likely related to the activation of HIF triggered by hypoxic exposure [ 52 ]. Specifically, HIF upregulates peroxisome proliferator-activated receptor gamma and peroxisome proliferator-activated receptor coactivator 1, both of which play key roles in improving lipid metabolism [ 43 , 53 ]. Additionally, HIF improves O 2 transport efficiency [ 17 ] by stimulating erythropoietin and nitric oxide secretion [ 52 ], thereby improving fatty acid oxidation [ 21 ]. Given that insulin resistance is a common complication in obese populations [ 54 ], our meta-analysis is the first to examine the effects of hypoxic intervention on insulin resistance by including the HOMA-IR index. Our results reveal that aerobic exercise training in hypoxia leads to a greater reduction in HOMA-IR (Fig. 8 ). This may be due to hypoxic conditions alleviating insulin resistance by improving insulin sensitivity, which in turn helps maintain healthy glucose metabolism [ 15 ]. Additionally, we found no significant difference in insulin and blood glucose reduction between hypoxia and normoxia when aerobic exercise training was performed at similar relative intensities (with lower absolute intensity in hypoxia) (Table 2 ). This aligns with a previous meta-analysis [ 18 ], suggesting that hypoxic interventions may provide similar benefits for glucose metabolism as normoxia, yet at a lower absolute intensity [ 37 , 55 ]. Furthermore, no significant differences were observed in LDL and HDL reductions between hypoxia and normoxia following aerobic training (all p > 0.05) (Table 2 ). This may be due to differences in exercise intensity. Previous studies have suggested that high exercise intensities (> 65% V̇O 2max or > 65% HRR or > 75% HR max ) are required to meaningfully improve HDL and LDL levels [ 1 , 56]. Most studies included in our meta-analyses utilized moderate-intensity (45–65% V̇O 2max or 50–65% HRR or 65–75% HR max ) exercise protocols, which may not have been sufficient to effectively reduce HDL and LDL levels in either hypoxic or normoxic conditions. 4.3 Subgroup analysis Hypoxia severity Our findings indicate that FiO₂ ≥ 15% more effectively reduces TG and LDL-C compared to FiO₂ < 15%, resulting in greater benefits for lipid metabolism (Table 3 ). Previous studies have indicated that total work and absolute intensity of exercise are key factors in improving lipid metabolism [ 18 ]. However, more severe hypoxic conditions may provide a stronger hypoxic stimulus [ 57 ], potentially reducing participants' total work and limiting the physiological benefits of aerobic exercise training in hypoxia for overweight and/or obese populations [ 18 , 58 ]. Frequency, session length, and training duration Compared to normoxia, aerobic exercise training in hypoxia with a duration of < 8 weeks, frequency of ≥ 4 days/week, and session length of ≥ 60 min resulted in larger reductions in BM, FBM, TG and LDL-C, effects not seen in other subgroups (Table 3 ). Consistent with our results, other meta-analysis has reported that prolonged hypoxic exposure and longer session can significantly reduce FBM and BM [ 20 ]. Therefore, a hypoxic intervention strategy involving moderate hypoxic exposure (FiO 2 > 15%) with sessions lasting ≥ 60 min, a frequency of ≥ 4 days/week, and a training duration of < 8 weeks appears to be effective for managing obesity. Age Subgroup analysis revealed that aerobic exercise training in hypoxia was more effective in improving FBM, TG, and LDL-C in overweight and/or obese individuals aged < 40 years compared to those aged ≥ 40 years (Table 3 ). This may be attributed to younger individuals having higher levels of hormones (e.g., growth hormone and testosterone) which promote fat mobilization and utilization while inhibiting fat synthesis, thereby leading to greater benefits from hypoxia exposure [ 51 ]. 5. Practical Implications Based on our results and the characteristics of the included studies, an effective hypoxic intervention strategy for overweight and/or obese individuals would involve a FiO 2 of 15.0-16.5%, a training duration of 3–8 weeks, a frequency of 4–5 days/week, and session lengths of 60–90 min. Furthermore, we recommend that practitioners consider the individual’s age and carefully control their circadian rhythms and energy intake both before and after training to develop a more comprehensive intervention strategy [ 20 ]. This approach will help to maximize energy expenditure and reduce energy intake, thereby leading to more effective obesity management. 6. Limitations and Future Directions This study has several limitations. First, most of the included studies employed moderate-intensity aerobic exercise training in hypoxia, so our meta-analysis did not examine the effects of aerobic exercise at varying intensities. It remains unclear whether higher exercise intensities would provide additional physiological benefits. Second, due to the lack of studies focusing on females only, our meta-analysis did not explore the impact of sex on the effects of hypoxic interventions. Evidence suggests that females tend to have higher fat reserves and a greater capacity to mobilize free fatty acids, which may modulate the effects of hypoxic interventions [ 59 , 60 ]. Lastly, some studies have reported that combined exercise modalities (e.g., aerobic exercise with resistance training) lead to larger improvements in body composition and metabolic health compared to aerobic exercise alone [ 3 , 4 , 22 ]. Future research should determine the most effective exercise modalities and consider the impact of potential factors (e.g., sex and exercise intensity). This would help develop more personalized, effective, and systematic intervention strategies tailored to individual characteristics. 7. Conclusion Aerobic exercise training in hypoxia is more effective than in normoxia for reducing body mass, fat body mass, triglycerides, and low-density lipoprotein cholesterol in overweight and/or obese individuals. These findings could inform the development of effective hypoxic exercise interventions for managing obesity, as this approach gains popularity. Abbreviations BM body mass BMI body mass index CI confidence intervals FBM fat body mass FiO 2 inspired oxygen fraction LBM lean body mass HC hip circumference HDL-C high-density lipoprotein cholesterol HOMA-IR homeostasis model assessment index of insulin resistance HDL high-density lipoprotein LDL low-density lipoprotein LDL-C low-density lipoprotein cholesterol MD mean difference O 2 oxygen SD standard deviation SE standard error SEM standard error of mean TC total cholesterol TG triglycerides WC waist circumference WHR waist-to-hip ratio V̇O 2max maximal oxygen uptake Declarations Acknowledgements We sincerely appreciate the participants for their valuable time and diligent effort in this study. Author contribution Y.C. and L.D. conceived and designed research. L.D. and J.H. contributed to data collection. L.D., J.H. and B.C. performed data analysis. J.L., L.D., L.G., and Y.C. interpreted the experimental results. L.D. and J.H. prepared figures. J.H. and L.D. drafted manuscript. L.D., J.H., J.L., B.C., L.G., O.G. and Y.C. edited and revised the manuscript. Funding This study was supported by the Shanghai Key Laboratory of Human Performance at Shanghai University of Sport (grant number: 11DZ2261100). Data Availability Data are available from the corresponding author upon reasonable request. Ethics Approval and Consent to Participate Not applicable. Consent for Publication Not applicable. Conflict of interest The authors declare that they have no competing interests. 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[37] 10 (2/8) 10 (2/8) 50.1 ± 13.0 45.5 ± 13.3 33.4 ± 3.1 32.8 ± 3.3 8/3 90 min of stepper, treadmill, bicycle ergometer at 60% HR max Normobaric, FiO 2 = 15.0% Intermittent, 90 min/day BM, TG, HDL Haufe et al. [35] 10 (10/0) 10 (10/0) 29.0 ± 5.9 28.1 ± 5.2 25.1 ± 1.9 24.0 ± 1.6 4/3 60 min of running at 3 mmol/L lactate Normobaric, FiO 2 = 15.0% Intermittent, 60 min/day BM, BMI, TG, LDL, HDL, HOMA-IR Wiesner et al. [13] 24 (10/14) 21 (8/13) 42.2 ± 1.2 42.1 ± 1.7 33.1 ± 0.3 32.5 ± 0.8 4/3 60 min of running at 65% V̇O 2max Normobaric, FiO 2 = 15.0% Intermittent, 60 min/day LBM, WC, LDL, SBP, DBP, Insulin, HOMA-IR Yang et al., [38] 10 (10/0) 8 (8/0) 22.5 ± 1.3 22.1 ± 2.2 30.7 ± 4.3 28.4 ± 2.8 4/5 60 min of cycling and running at 71-76% V̇O 2max Normobaric, FiO 2 = 15.0% Intermittent, 60 min/day BM, BMI, FBM, TC, TG, LDL, HDL Gatterer et al. [34] 16 (4/12) 16 (6/10) 50.3 ± 10.3 52.4 ± 7.9 37.9 ± 8.1 36.3 ± 4.0 32/2 90 min of cycling, running and cross trainer at 65-70% HR max and rested for additional 90 min in normobaric hypoxic chambers Normobaric, FiO 2 = 14.0 ± 0.2% Intermittent, 180 min/day BM, BMI, FBM, WC, HC, WHR, TC, TG, HDL, Glucose, SBP, DBP Zhao et al. [39] 9 (9/0) 9 (9/0) 18.2 ± 2.2 18.1 ± 1.7 32. 9 31. 5 8/5 60 min of cycling at 65-75% V̇O 2max Normobaric, FiO 2 = 14.7% Intermittent, 60 min/day BM, FBM Park et al. [40] 11 (0/11) 12 (0/12) 42.0 ± 4.4 47.2 ± 6.3 > 30 > 30 6/5 60 min of treadmill and bicycle at 75% HR max Normobaric, FiO 2 = 16.5% Intermittent, 60 min/day BM, FBM, TC, LDL-C, HDL-C, SBP, DBP Shin et al. [14] 8 (8/0) 9 (9/0) 45.6 ± 20.9 46.0 ± 20.5 26.8 ± 2.3 27.0 ± 3.0 4/3 50 min of running in treadmill at 60% HR max , (5 min warm-up; 40 min main set and 5 min cold down) Normobaric, FiO 2 = 15.0% Intermittent, 50 min/day BM, BMI, FBM, WC, TC, TG, LDL-C, HDL-C, HOMA-IR klug et al. [36] 12 (12/0) 11 (11/0) 55.0 ± 7.3 57.6 ± 7.3 35.5 ± 4.8 34.1 ± 3.0 6/3 60 min of walking at 60% HR max Normobaric, FiO 2 = 15.0% Intermittent, 60 min/day BM, BMI, LBM, FBM, WC, HC, WHR, TG, LDL, HDL, Glucose, Insulin, SBP, DBP Fernández et al. [33] 12 (2/10) 11 (2/9) 34.8 ± 4.7 32.2 ± 8.4 34.0 ± 2.6 32.9 ± 2.7 3/3 60 min of walking at six different speeds Normobaric, FiO 2 = 14.5% Intermittent, 60 min/day BM, BMI, LBM, FBM, TC, TG, LDL-C, HDL-C, Insulin, HOMA-IR Zhang et al. [23] 20 (20/0) 20 (20/0) 22.3 ± 2.2 21.9 ± 2.3 32.8 ± 1.2 33.3 ± 2.1 4/5 60 min of cycling at 65% V̇O 2max Normobaric, FiO 2 = 15.0% Intermittent, 60 min/day BM, BMI, FBM, TC, TG, LDL-C, HDL-C chacaroun et al., [24] 12 (11/1) 11 (8/3) 52.0 ± 12.0 56.0 ± 11.0 31.2 ± 2.4 31.8 ± 3.2 8/3 45 min of cycling at 75 ± 2% HR max Normobaric, FiO 2 = 13.0% Intermittent, 45 min/day BMI, LBM, FBM, WC, HC, TC, TG, LDL, HDL, Insulin, SBP, DBP, HOMA-IR Namboonlue et al. [25] 10 (10/0) 10 (10/0) 20.3 ± 0.9 19.8 ± 0.4 26.3 ± 3.4 27.0 ± 1.9 5/3 30 min of running at 60% HRR (5 min warm-up; 20 min main set and 5 min cold down) Normobaric, FiO 2 = 15.8% Intermittent, 30 min/day BM, BMI, LBM M: male; F: female; NA: no available; FiO 2 : inspired fraction of oxygen; HR max : maximum heart rate; V̇O 2max : maximal oxygen consumption; HRR: heart rate reserve; BM: body mass; BMI: body mass index; LBM: lean body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high density lipoprotein cholesterol; LDL: low density lipoprotein; HDL: high density liporotein; Intermittent: hypoxic training consisting of hypoxia exposure lasting seconds to hours with a return to normoxia or lower levels of hypoxia and repetition over days to weeks. Table 2 Summary of meta-analyses Outcomes Indices N Mean difference (95% of CI) p I 2 ( p ) Bias Body Composition BM 12 -0.90 (-1.80, -0.01) 0.05 0% (0.98) Egger: p = 0.30; Begg: p = 0.63 BMI 9 -0.57 (1.35, 0.20) 0.15 0% (0.63) Egger: p = 0.88; Begg: p = 0.47 LBM 4 0.71 (-3.09, 4.52) 0.71 0% (0.98) Egger: p = 0.49; Begg: p = 1.00 FBM 10 -1.22 (-2.59, 0.15) 0.08 0% (0.97) Egger: p = 0.09; Begg: p = 0.37 WC 5 -0.52 (-3.95, 2.91) 0.77 0% (0.99) Egger: p = 0.52; Begg: p = 0.81 HC 3 -0.22 (-4.41, 3.89) 0.92 0% (0.95) Egger: p = 0.59; Begg: p = 1.00 WHR 2 -0.00 (-0.05, 0.04) 0.85 0% (0.82) Metabolism TC 8 -1.51 (-9.82, 6.80) 0.72 0.5% (0.43) Egger: p = 0.43; Begg: p = 0.90 TG 9 -10.78 (-20.68, -0.88) < 0.05 0% (0.53) Egger: p = 0.98; Begg: p = 0.75 HDL-C 5 -1.65 (9.19, 5.88) 0.67 70% (0.01) Egger: p = 0.96; Begg: p = 0.46 LDL-C 5 -5.28 (-8.75, -1.81) < 0.05 0% (0.96) Egger: p = 0.41; Begg: p = 0.22 LDL 5 4.31 (3.61, 12.23) 0.29 0% (0.99) Egger: p = 0.04; Begg: p = 0.46 HDL 6 -1.68 (6.99, 3.63) 0.54 0% (0.46) Egger: p = 0.60; Begg: p = 1.00 Glucose 3 -1.74 (-16.24, 12.76) 0.81 0% (0.97) Egger: p = 0.31; Begg: p = 1.00 Insulin 5 0.62 (-1.66, 2.89) 0.60 0% (0.49) Egger: p = 0.70; Begg: p = 1.00 HOMA-IR 5 -0.22 (-0.33, -0.11) < 0.05 0% (0.50) Egger: p = 0.40; Begg: p = 0.81 BM: body mass; BMI: body mass index; LBM: lean body mass; FBM: fat body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance. Bold text signifes statistically signifcant results. Table 3 Summary of subgroup analyses Outcomes N Mean difference (95% of CI) p I 2 ( p ) BM Age: ≥ 40 years 6 -0.94 (-2.26, 0.38) 0.16 0% (0.99) Age: < 40 years 6 -0.87 (-2.09, 0.34) 0.16 0% (0.64) FiO 2 : ≥ 15% 8 -0.85 (-1.77, 0.06) 0.07 0% (0.99) FiO 2 : < 15% 4 -2.00 (-6.29, 2.30) 0.36 0% (0.58) Frequency: ≥ 4 days/week 5 -2.27 (-4.98, 0.44) 0.10 0% (0.72) Frequency: < 4 days/week 7 -0.73 (-1.68, 0.21) 0.13 0% (0.99) Session length: ≥ 60 min 10 -0.89 (-1.80, 0.01) 0.05 0% (0.94) Session length: < 60 min 2 -1.25 (-7.55, 5.06) 0.70 0% (0.89) Duration: ≥ 8 weeks 3 -1.30 (-3.36, 0.75) 0.21 4.2% (0.35) Duration: < 8 weeks 9 -0.73 (-1.90, 0.44) 0.22 0% (0.99) BMI Age: ≥ 40 years 4 0.08 (-1.40, 1.55) 0.92 0% (0.91) Age: < 40 years 5 -0.86 (-1.88, 0.15) 0.10 0% (0.63) FiO 2 : ≥ 15% 6 0.20 (-1.33, 1.73) 0.07 0% (0.86) FiO 2 : < 15% 3 -0.85 (-1.75, 0.06) 0.80 0% (0.48) Frequency: ≥ 4 days/week 2 0.46 (-1.63, 2.55) 0.67 0% (0.67) Frequency: < 4 days/week 7 -0.24 (-1.09, 0.60) 0.08 0% (0.63) Session length: ≥ 60 min 6 -0.74 (-1.58, 0.10) 0.09 0% (0.44) Session length: < 60 min 3 -0.05 (-1.46, 1.37) 0.95 0% (0.74) Duration: ≥ 8 weeks 2 0.46 (-1.63, 2.55) 0.67 0% (0.67) Duration: < 8 weeks 7 -0.74 (-1.58, 0.10) 0.08 0% (0.56) LBM Age: ≥ 40 years 2 0.29 (-5.43, 6.02) 0.92 0% (0.82) Age: < 40 years 2 1.05 (-4.03, 6.13) 0.69 0% (0.98) FiO 2 : ≥ 15% 2 0.95 (-4.87, 6.77) 0.75 0% (0.69) FiO 2 : < 15% 2 0.54 (-4.48, 5.56) 0.83 0% (0.92) FBM Age: ≥ 40 years 6 -0.43 (-2.50, 1.64) 0.69 0% (0.99) Age: < 40 years 4 -1.84 (-3.66, -0.02) 0.05 0% (0.97) FiO 2 : ≥ 15% 5 -1.54 (-3.55, 0.47) 0.13 0% (0.94) FiO 2 : < 15% 5 -0.95 (-2.82, 0.92) 0.32 0% (0.74) Frequency: ≥ 4 days/week 5 -1.78 (-3.46, -0.01) < 0.05 0% (0.89) Frequency: < 4 days/week 5 -0.09 (-2.47, 2.30) 0.95 0% (0.97) Session length: ≥ 60 min 8 -1.24 (-2.70, 0.21) 0.09 0% (0.90) Session length: < 60 min 2 -1.06 (-5.08, 2.97) 0.61 0% (0.74) Duration: ≥ 8 weeks 2 -1.99 (-4.73, 0.75) 0.16 0% (0.97) Duration: < 8 weeks 8 -0.97 (-2.55, 0.61) 0.23 0% (0.97) WC Age: ≥ 40 years 3 -0.20 (-4.55, 4.15) 0.93 0% (0.94) Age: < 40 years 2 -1.05 (-6.63, 4.52) 0.71 0% (0.70) FiO 2 : ≥ 15% 3 -1.26 (-6.04, 3.51) 0.60 0% (0.94) FiO 2 : < 15% 2 0.27 (-4.66, 5.91) 0.92 0% (0.98) TC Age: ≥ 40 years 5 9.75 (-2.95, 22.45) 0.13 0% (0.92) Age: < 40 years 3 -9.87 (-20.74,1.01) 0.08 0% (0.66) FiO 2 : ≥ 15% 4 -7.93 (-18.58, 2.73) 0.15 0% (0.57) FiO 2 : < 15% 4 8.02 (-5.06, 21.09) 0.23 0% (0.67) Frequency: ≥ 4days/week 4 -2.82 (-16.74,11.07) 0.69 33.4% (0.21) Frequency: < 4days/week 4 5.61 (-9.94, 21.16) 0.48 0% (0.71) Session length: ≥ 60 min 2 0.01 (-11.48, 11.50) 0.99 28.5% (0.22) Session length: < 60 min 6 0.73 (-24.62, 26.09) 0.95 0% (0.92) Duration: ≥ 8 weeks 5 9.93 (-0.48, 20.35) 0.32 0% (0.37) Duration: < 8 weeks 6 -4.11 (-13.23, 5.02) 0.38 0% (0.47) TG Age: ≥ 40 years 5 -8.56 (-37.83, 20.70) 0.57 0% (0.43) Age: < 40 years 4 -10.93 (-20.78, -1.08) 0.08 8.1% (0.35) FiO 2 : ≥ 15% 6 -13.28(-23.49, -3.08) < 0.05 0% (0.69) FiO 2 : < 15 % 3 20.98 (-16.60, 58.55) 0.27 0% (0.59) Frequency: ≥ 4 days/week 2 -20.95 (-61.42, 19.52) 0.31 27.1% (0.24) Frequency: < 4 days/week 7 -6.00 (-23.31, 11.31) 0.50 0% (0.51) Session length: ≥ 60 min 7 -10.80(-20.85, -0.70 < 0.05 0% (0.46) Session length: < 60 min 2 -22.68 (-94.91, 49.55) 0.59 31.6% (0.23) Training duration: ≥ 8 weeks 3 -2.38 (-36.04, 31.28) 0.89 12.4% (0.32) Training duration: < 8 weeks 6 -11.78 (-22.16, -1.40) < 0.05 0% (0.47) LDL-C Age: ≥ 40 years 3 -1.12 (-17.94, 15.69) 0.90 0% (0.83) Age: < 40 years 2 -5.47 (-9.01, -1.92) < 0.05 0% (0.86) FiO 2 : ≥ 15% 3 -5.34 (-8.88, -1.79) < 0.05 0% (0.79) FiO 2 : < 15% 2 -3.93 (-21.11, 13.26) 0.65 0% (0.68) Frequency: ≥ 4 days/week 3 -5.28 (-8 75, -1.82) < 0.05 0% (0.96) Frequency: < 4 days/week 2 -3.27 (-24.49, 17.94) 0.76 0% (0.51) HDL-C Age: ≥ 40 years 3 2.79 (-2.06, 7.63) 0.26 0% (0.97) Age: < 40 years 2 -7.67 (-21.55, 6.21) 0.28 76.1% (0.04) FiO 2 : ≥ 15% 3 -3.98 (-16.79, 8.83) 0.54 79.1% (0.01) FiO 2 : < 15% 2 2.40 (-3.42, 8.21) 0.42 0% (0.62) Frequency: ≥ 4 days/week 3 -2.79 (-13.51, 7.93) 0.61 69.6% (0.01) Frequency: < 4 days/week 2 0.74 (-8.94, 10.43) 0.88 0% (0.79) LDL Age: ≥ 40 years 2 0.79 (-22.23, 23.92) 0.95 0% (0.93) Age: < 40 years 3 4.31 (-3.61, 12.23) 0.27 0% (0.99) HDL Age: ≥ 40 years 4 -1.42 (-7.83, 4.98) 0.66 14.9% (0.32) Age: < 40 years 2 -3.09 (-17.01, 10.83) 0.66 8.2% (0.30) FiO 2 : ≥ 15% 4 -0.61 (-7.51, 6.29) 0.86 0% (0.19) FiO 2 : < 15% 2 -3.69 (-14.80, 7.42) 0.52 42.6% (0.46) Trainin g duration: ≥ 8 weeks 3 -0.53 (-10.19, 9.13) 0.91 40.8% (0.19) Training duration: < 8 weeks 3 -2.85 (-10.59, 4.88) 0.49 0% (0.58) Insulin Age: ≥ 40 years 3 0.23 (-3.62, 4.08) 0.91 9.4% (0.33) Age: < 40 years 2 1.03 (-2.28, 4.34) 0.54 9.5% (0.29) FiO 2 : ≥ 15% 3 0.26 (-3.17, 3.69) 0.88 9.1% (0.33) FiO 2 : < 15% 2 1.19 (-2.46, 4.85) 0.52 4.7% (0.31) Session length: ≥ 60 min 3 1.37 (-1.47, 4.21) 0.34 0% (0.39) Session length: < 60 min 2 -0.74 (-4.55, 3.07) 0.70 0% (0.38) HOMA-IR Age: ≥ 40 years 2 -0.04 (-0.59, 0.50) 0.88 0% (0.40) Age: < 40 years 3 -0.19 (-0.41, 0.02) 0.08 11.7% (0.32) FiO 2 : ≥ 15% 3 -0.24 (-0.35, -0.13) < 0.05 0% (0.79) FiO 2 : < 15% 2 0.14 (-0.33, 0.61) 0.56 0% (0.50) Session length: ≥ 60 min 3 -0.19 (-0.41, 0.02) 0.08 11.7% (0.32) Session length: < 60 min 2 -0.04 (-0.59, 0.50) 0.88 0% (0.40) FiO 2 : inspired fraction of oxygen; BM: body mass; BMI: body mass index; LBM: lean body mass; FBM: fat body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high- density lipoprotein cholesterol; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance. Bold text signifes statistically signifcant results. Cite Share Download PDF Status: Published Journal Publication published 01 Oct, 2025 Read the published version in Sports Medicine-Open → Version 1 posted Editorial decision: Major Revision 22 Jun, 2025 Reviewers agreed at journal 07 Jan, 2025 Reviewers invited by journal 03 Jan, 2025 Editor assigned by journal 02 Dec, 2024 First submitted to journal 30 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5556421","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":397335606,"identity":"32901dff-2d39-4060-8f12-59d8a786c9d2","order_by":0,"name":"Li Ding","email":"","orcid":"","institution":"Shanghai University of Sport School of Athletic Performance","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Ding","suffix":""},{"id":397335607,"identity":"e48a3531-8d56-46f7-bbbb-6502946a0929","order_by":1,"name":"Jin Huang","email":"","orcid":"","institution":"Shanghai University of Sport School of Athletic Performance","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Huang","suffix":""},{"id":397335608,"identity":"2f32636c-de4e-4f86-9f5e-8c388f629da2","order_by":2,"name":"Jue Liu","email":"","orcid":"","institution":"Huashan Hospital Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jue","middleName":"","lastName":"Liu","suffix":""},{"id":397335609,"identity":"c1787d80-80d2-430e-9d4d-74630dd644a6","order_by":3,"name":"Li Guo","email":"","orcid":"","institution":"Shanghai University of Sport School of Exercise and Health","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Guo","suffix":""},{"id":397335610,"identity":"4bfe68b1-b6ad-4d93-b721-83cb4ffb0619","order_by":4,"name":"Bin Chen","email":"","orcid":"","institution":"Fujian Agriculture and Forestry University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Chen","suffix":""},{"id":397335611,"identity":"cb1fa598-74ce-4525-8b87-0ec293b97e3e","order_by":5,"name":"Yinhang Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLCCBIYDQJL5AIR3gHgtbAkkaIEo4zEgTgt/++FjEg933JE351/z+TPPHwY5vhsJjJ8L8GiROJOWJpF45pnhzhlvt0nztjEYS95IYJaegUeLAUOOmURi22HGDTfObmPmbWBI3HAjgY2ZB58W/jdgLfYbbpx5DHJYPWEtEhBbEjec72GQ5mFjSDAgpEXixrNkC6CW5A032Mwk57ZJGM4887BZGp8W/v7kgzd/th223XD+8OMPb/7YyPMdTz74GZ8WIGCRgNiXACaBmLEBvwZgQvkAse8AIYWjYBSMglEwUgEArnZS0XVRkhYAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-2323-3707","institution":"Shanghai University of Sport","correspondingAuthor":true,"prefix":"","firstName":"Yinhang","middleName":"","lastName":"Cao","suffix":""},{"id":397335612,"identity":"19f7fbf5-ac9c-49a8-a5d8-7bde47c59991","order_by":6,"name":"Olivier Girard","email":"","orcid":"","institution":"The University of Western Australia School of Human Sciences","correspondingAuthor":false,"prefix":"","firstName":"Olivier","middleName":"","lastName":"Girard","suffix":""}],"badges":[],"createdAt":"2024-12-01 01:57:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5556421/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5556421/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40798-025-00918-6","type":"published","date":"2025-10-01T15:56:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73023372,"identity":"35d0bdde-d677-4481-bf62-3926de728294","added_by":"auto","created_at":"2025-01-06 04:23:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120178,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of study selection\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/d54242323cebb2003c8450cd.jpg"},{"id":73023385,"identity":"3f5bb823-58b3-4f5b-bb07-8a3fe90a5d7e","added_by":"auto","created_at":"2025-01-06 04:23:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":503783,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias summary of included studies\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/de62f70224e7a076b787ac4b.jpg"},{"id":73023369,"identity":"039df475-5458-46dc-b727-75f93c38888f","added_by":"auto","created_at":"2025-01-06 04:23:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":863694,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot of mean difference against standard error for outcome. SE (MD): error of the mean difference\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/5859fbddd5d904f19334a22e.png"},{"id":73023367,"identity":"83932401-8acd-4e8d-9ee8-f1fa42505b61","added_by":"auto","created_at":"2025-01-06 04:23:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":13432,"visible":true,"origin":"","legend":"\u003cp\u003eTotal effects of the intervention on body mass in hypoxia compared to normoxia. Filled green squares represent study-specific estimates, while the filled diamond represents pooled estimates of random-effects. CI: confidence interval, SD: standard deviation\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/909f0ef8e72c273292bd790e.png"},{"id":73023392,"identity":"db95fe27-8239-49a2-bb11-b0b72dad9d26","added_by":"auto","created_at":"2025-01-06 04:23:49","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":12875,"visible":true,"origin":"","legend":"\u003cp\u003eTotal effects of the intervention on fat body mass in hypoxia compared to normoxia. Filled green squares represent study-specific estimates, while the filled diamond represents pooled estimates of random-effects. CI: confidence interval, SD: standard deviation\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/037b861d2852a498a16bf03c.png"},{"id":73023565,"identity":"53bd018d-257b-44d9-9298-a45da669cdb1","added_by":"auto","created_at":"2025-01-06 04:31:49","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":12628,"visible":true,"origin":"","legend":"\u003cp\u003eTotal effects of the intervention on triglyceride in hypoxia compared to normoxia. Filled green squares represent study-specific estimates, while the filled diamond represents pooled estimates of random-effects. CI: confidence interval, SD: standard deviation\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/20a113c367aa2a484997e66a.png"},{"id":73023374,"identity":"9447c88b-5d75-449d-8a54-e86ee9df6eb9","added_by":"auto","created_at":"2025-01-06 04:23:48","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":10255,"visible":true,"origin":"","legend":"\u003cp\u003eTotal effects of the intervention on low-density lipoprotein cholesterol in hypoxia compared to normoxia. Filled green squares represent study-specific estimates, while the filled diamond represents pooled estimates of random-effects. CI: confidence interval, SD: standard deviation\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/cab8a28870138cb3978a9648.png"},{"id":73023568,"identity":"520ed751-a9b4-4f04-9e56-6a6eb0d37b1c","added_by":"auto","created_at":"2025-01-06 04:31:49","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":10283,"visible":true,"origin":"","legend":"\u003cp\u003eTotal effects of the intervention on homeostasis model assessment of insulin resistance in hypoxia compared to normoxia. Filled green squares represent study-specific estimates, while the filled diamond represents pooled estimates of random-effects. CI: confidence interval, SD: standard deviation\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/2168cb1ba9c489ac702033da.png"},{"id":92883627,"identity":"a6885a6a-d6d0-4e63-a050-d9653c46427c","added_by":"auto","created_at":"2025-10-06 16:06:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2844346,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5556421/v1/2c169fa1-399e-4f8f-8aa3-75c6e45f7845.pdf"}],"financialInterests":"","formattedTitle":"Effects of Aerobic Exercise Training in Hypoxia versus Normoxia on Body Composition and Metabolic Health in Overweight and/or Obese Population: An updated Meta-Analysis","fulltext":[{"header":"Key points","content":"\u003cul\u003e\n \u003cli\u003eAerobic exercise training in hypoxia led to larger reductions in body mass, fat body mass, triglycerides, and low-density lipoprotein cholesterol in overweight and/or obese individuals.\u003c/li\u003e\n \u003cli\u003eModerate hypoxia protocols (FiO\u003csub\u003e2\u003c/sub\u003e \u0026ge; 15%) with sessions lasting \u0026ge; 60 min, \u0026ge; 4 days/week, and \u0026lt; 8 weeks of training were effective in managing obesity, particularly in individuals aged \u0026lt; 40 years.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eAerobic exercise, defined as the rhythmic movement of the body's large muscles for at least 10 min [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], is a well-established strategy for obesity management [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], improving metabolism and supporting healthy body composition [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization recommends moderate-to-high intensity aerobic exercise as an effective intervention for weight loss in individuals with obesity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, higher intensity exercises may be less enjoyable and harder to due to the greater body mass of overweight and obese individuals [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, such exercises can increase the risk of musculoskeletal injuries, potentially undermining weight loss efforts [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Consequently, it is imperative to develop safe, well-tolerated, and effective aerobic exercise strategies tailored to the specific needs of this population.\u003c/p\u003e \u003cp\u003eIn recent years, exercise training in low oxygen conditions (hypoxia) has emerged as a promising intervention for obesity management [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For instance, studies have compared aerobic exercise training (50\u0026ndash;60 min of running, 3 days/week for 4 weeks at 60\u0026ndash;65% of maximal oxygen uptake [V̇O\u003csub\u003e2max\u003c/sub\u003e]) in normoxia and hypoxia (inspired oxygen fraction [FiO\u003csub\u003e2\u003c/sub\u003e]\u0026thinsp;=\u0026thinsp;15%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, 14]. These studies found that hypoxic training leads to greater improvements in body composition (e.g., body mass index [BMI], fat body mass [FBM], and waist circumference) and metabolic markers (e.g., blood glucose, insulin, total cholesterol, and triglycerides [TG]) at lower absolute exercise intensities[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, 14]. These benefits are thought to result from hypoxia\u0026rsquo;s potential to boost glucose uptake and transport [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], fat oxidation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and appetite regulation through the activation of hypoxia-inducible factors (HIF) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], ultimately improving health markers [16].\u003c/p\u003e \u003cp\u003eSeveral meta-analyses have compared the effects of exercise training on body composition and metabolism between hypoxia and normoxia [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], but the results remain inconsistent. Some meta-analyses reported larger reductions in TG [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], FBM and BMI [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] following hypoxic compared to normoxic training, while others found no significant differences between conditions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, these meta-analyses present several limitations: (a) the inclusion of other exercise modalities, such as resistance training and high-intensity interval training [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which are less effective for fat loss in obese populations compared to aerobic exercise [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], potentially reducing the effects of hypoxic interventions; (b) the lack of subgroup analyses for accounting for variables like hypoxic dose (e.g., severity), exercise intervention (e.g., duration, frequency), and population characteristics (e.g., age), leading to substantial heterogeneity (\u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026gt; 50%) [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Since our previous meta-analysis on the effects of hypoxic exposure on fat loss and cardiometabolic markers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], several new randomized controlled trials have been published [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], highlighting the need for an updated meta-analysis that incorporates more comprehensive data.\u003c/p\u003e \u003cp\u003eThe purpose of this meta-analysis was to evaluate the efficacy of aerobic exercise training on body composition and metabolic health in overweight and/or obese individuals, comparing the effects of hypoxia and normoxia. Additionally, we explored factors that may influence these outcomes and provide practical recommendations to optimize hypoxic training interventions.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024577543).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Literature search\u003c/h2\u003e \u003cp\u003eWe searched five databases (PubMed, Web of Science, EMBASE, Scopus, and CNKI) from their inception to 10 November 2024. The search used specific terms and Boolean operators ('AND,' 'OR,' 'NOT'): \u0026ldquo;hypoxia\u0026rdquo;, \u0026ldquo;altitude\u0026rdquo;, \u0026ldquo;hypoxic\u0026rdquo;, \u0026ldquo;exercise\u0026rdquo;, \u0026ldquo;aerobic\u0026rdquo;, \u0026ldquo;body composition\u0026rdquo;, \u0026ldquo;FBM\u0026rdquo;, \u0026ldquo;lean mass\u0026rdquo;, \u0026ldquo;muscle mass\u0026rdquo;, \u0026ldquo;fat-free mass\u0026rdquo;, \u0026ldquo;weight loss\u0026rdquo;, \u0026ldquo;fat loss\u0026rdquo;, \u0026ldquo;metabolism\u0026rdquo;, \u0026ldquo;metabolic\u0026rdquo; \u0026ldquo;overweight\u0026rdquo;, \u0026ldquo;obesity\u0026rdquo;, \u0026ldquo;obese\u0026rdquo;. When necessary, we contacted authors via email to request missing data and conducted manual searches using Google Scholar to ensure comprehensive coverage of relevant literature.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Selection criteria\u003c/h2\u003e \u003cp\u003eEach study included was required to meet the following the criteria based on the participants, interventions, comparators, outcomes, and study design (PICOS) framework: (1) participants were overweight (body mass index [BMI]\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e) and/or obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e), without physical activity restrictions or severe diseases that could impede exercise interventions; (2) the intervention involved aerobic exercise training in hypoxia (simulated altitude\u0026thinsp;\u0026ge;\u0026thinsp;2000 m or FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026le;\u0026thinsp;16.5%) at least 2 days/week with moderate-to-high intensity (\u0026ge;\u0026thinsp;45% V̇O\u003csub\u003e2max\u003c/sub\u003e or \u0026ge;\u0026thinsp;50% heart rate reserve [HHR] or \u0026ge;\u0026thinsp;60% maximum heart rate [HR\u003csub\u003emax\u003c/sub\u003e]) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, 27]; (3) an equivalent aerobic exercise training protocol in normoxia was used as a comparator; (4) outcomes related to body composition (body mass [BM], BMI, lean body mass [LBM], FBM, waist circumference [WC], hip circumference [HC], waist-to-hip ratio [WHR]) and metabolic health (total cholesterol [TC], TG, low-density lipoprotein [LDL], high-density lipoprotein [HDL], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], glucose, insulin, and homeostasis model assessment index of insulin resistance [HOMA-IR]) were reported; (5) the study design utilized a randomized controlled trial.\u003c/p\u003e \u003cp\u003eStudies were excluded based on the following criteria: (1) participants had severe diseases that could hinder exercise interventions (e.g., cardiovascular diseases or type 2 diabetes); (2) the intervention combined aerobic exercise with other types of training (e.g., interval training, resistance training, or whole-body vibration); (3) blood flow restriction was used as the hypoxic intervention; (4) full-text articles or data extraction was unavailable; (5) the study was a conference abstract, review, case report, or animal experiment; (6) the study was not published in English or Chinese.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study selection\u003c/h2\u003e \u003cp\u003eThe retrieved literature was imported into EndNote (Version X9, Clarivate Analytics, Philadelphia, USA) reference management software, and duplicates were removed. During the initial screening, two independent investigators (H.J. and D.L.) reviewed the titles and abstracts of all studies to identify potentially relevant ones. Full-texts of the relevant studies were then obtained and assessed for compliance with the inclusion and exclusion criteria. Any disagreements between the two investigators were resolved through consultation with a third investigator (C.Y.), who helped finalize the list of included studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data extraction\u003c/h2\u003e \u003cp\u003eTwo independent investigators (H.J. and D.L.) extracted relevant data from the eligible studies, including: (1) basic information (author [s], year of publication and title); (2) participant characteristics (sample size, age, sex, and BMI); (3) hypoxic exposure (hypoxia severity, duration, and pattern); (4) exercise protocol (duration, frequency, and session length); (5) outcome indicators (mean value, standard deviation [SD], and sample size). If studies did not report the mean values and SD of the differences before and after the intervention, these were calculated using the following formula [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:Mean={Mean}_{after}-{Mean}_{before}$$\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:SD=\\:\\sqrt{{SD}_{before}^{2}+{SD}_{after}^{2}-2\\times\\:Corr\\times\\:{SD}_{before}\\times\\:{SD}_{after}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cem\u003eMean\u003c/em\u003e\u003csub\u003e\u003cem\u003ebefore\u003c/em\u003e\u003c/sub\u003e and \u003cem\u003eMean\u003c/em\u003e\u003csub\u003e\u003cem\u003eafter\u003c/em\u003e\u003c/sub\u003e represent the means of the pre-intervention and post-intervention, respectively. \u003cem\u003eSD\u003c/em\u003e\u003csub\u003e\u003cem\u003ebefore\u003c/em\u003e\u003c/sub\u003e and \u003cem\u003eSD\u003c/em\u003e\u003csub\u003e\u003cem\u003eafter\u003c/em\u003e\u003c/sub\u003e represent the SDs of the pre-intervention and post-intervention, respectively. \u003cem\u003eCorr\u003c/em\u003e is the correlation coefficient between the hypoxic and normoxia groups, often assumed to be 0.5 when no correlation is reported [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Assessment of methodological quality\u003c/h2\u003e \u003cp\u003eThe methodological quality and risk of bias of all included studies were assessed following the Cochrane guidelines [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The Cochrane risk of bias assessment tool examines studies across several domains: (1) random sequence generation; (2) allocation concealment; (3) blinding of participants and personnel; (4) blinding of outcome assessment; (5) incomplete outcome data; (6) selective reporting; and (7) other potential sources of bias. Each domain was rated as 'low risk' ('+'), 'high risk' ('-'), or 'unclear risk' ('?'). Two independent investigators (D.L. and H.J.) carried out the assessments using Review Manager software (Version 5.4, the Cochrane Collaboration, Oxford, UK). Any discrepancies in the risk of bias ratings were resolved through discussion and, when necessary, by involving a third reviewer (C.Y.).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003e Data analysis was performed using Review Manager software (version 5.4, The Cochrane Collaboration, Oxford, UK) and Stata software (version 14, Stata Corp, TX, USA). After standardizing the extracted variables to consistent units, a random-effects model was applied to assess the differences in outcomes between hypoxic and normoxic interventions. Results were reported as mean differences (MD), 95% confidence intervals (CI), and \u003cem\u003ep\u003c/em\u003e-values [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Study heterogeneity was quantified using the \u003cem\u003eI\u0026sup2;\u003c/em\u003e statistic, classified as low (\u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026lt; 25%), moderate (25% \u0026le; \u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026le; 50%), or high (\u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026gt; 50%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Publication bias was assessed via funnel plots, along with Begg's and Egger's tests. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eIn line with prior research [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], subgroup analyses were conducted to examine the effect of potential factors: (1) age (\u0026lt;\u0026thinsp;40 years vs. \u0026ge; 40 years); (2) hypoxia severity (FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;15% vs. \u0026ge; 15%); (3) frequency (\u0026lt;\u0026thinsp;4 days/week and \u0026ge;\u0026thinsp;4 days/week); (4) training duration (\u0026lt;\u0026thinsp;8 weeks vs. \u0026ge; 8 weeks); and (5) session length (\u0026le;\u0026thinsp;60 min vs. \u0026gt; 60 min).\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Search results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 5267 studies were identified from the databases. After removing 2488 duplicates, 2779 studies were excluded based on titles and abstracts. Fifty-one studies underwent full-text screening, and 13 studies met the inclusion criteria and were included in the analysis [13, 14, 23-25, 33-40] (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Figure 1 about here------------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Study characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 14 trials from 13 studies (one study was included twice due to two groups with different hypoxia severities) were analyzed quantitatively (Table 1). The total number of participants across the 14 trials was 346 (hypoxia: 176; normoxia: 170). Participants\u0026rsquo; ages ranged from 18 to 57 years, and BMIs between 25.1 and 37.9 kg/m\u003csup\u003e2\u003c/sup\u003e. The duration of the aerobic exercise training interventions varied between 3 and 32 weeks, with session lengths ranging from 20 to 90 min, frequencies from 2 to 5 days/week, and intensities from 60% to 75% V̇O\u003csub\u003e2max\u003c/sub\u003e or 60% to 75% HR\u003csub\u003emax\u003c/sub\u003e.\u0026nbsp;In the hypoxia groups, FiO\u003csub\u003e2\u003c/sub\u003e ranged from 13.0% to 16.5%. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Table 1 about here------------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Quality of study methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRisk of bias was evaluated for the 13 included studies. One study was rated as high risk due to incomplete outcome data, while the remaining 12 studies were considered moderate risk (Figure 2). The funnel plot indicated slight asymmetry, suggesting possible publication bias (Figure 3). Since funnel plots are subjective, further objective evaluation was performed using Begg\u0026apos;s and Egger\u0026apos;s tests. Most major outcomes showed \u003cem\u003ep\u003c/em\u003e-values greater than 0.05, except for LDL (\u003cem\u003ep\u003c/em\u003e = 0.04), indicating no significant publication bias for these outcomes (tests for WHR were not conducted due to fewer than three studies) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Figure 2 and 3 about here------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Table 2 and 3 about here-------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Meta-analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBody composition\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe meta-analysis summary on body composition indicators is shown in Table 2. Compared to normoxia, aerobic exercise training in hypoxia showed larger reduction in BM (MD = -0.90, 95% CI: -1.80 to -0.01, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0%, Figure 4) and a favorable trend towards larger FBM loss (MD = -1.22, 95% CI: -2.59 to 0.15, \u003cem\u003ep\u003c/em\u003e = 0.08, \u003cem\u003eI\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= 0%, Figure 5) in overweight and/or obese populations. However, no significant differences were observed between hypoxia and normoxia for BMI, LBM, WC, HC, and WHR (all \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Figure 4 and 5 about here------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe summary of the subgroup analysis is shown in Table 3. Aerobic exercise training in hypoxia resulted in greater BM loss compared to normoxia for session lengths of \u0026ge; 60 min (MD = \u0026minus;0.89, 95% CI: -1.80 to -0.01, \u003cem\u003ep\u003c/em\u003e = 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), but not for session lengths of \u0026lt; 60 min (MD = -1.25, 95% CI: -7.55 to 5.06, \u003cem\u003ep\u003c/em\u003e = 0.70, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%). A favorable trend towards greater BM loss in hypoxia was also noted at FiO₂ \u0026ge; 15% (MD = -0.85, 95% CI: -1.77 to 0.06, \u003cem\u003ep\u003c/em\u003e = 0.07, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), but not at FiO₂ \u0026lt; 15% (MD = -2.00, 95% CI: -6.29 to 2.30, \u003cem\u003ep\u003c/em\u003e = 0.36, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%). Furthermore, hypoxia led to larger reductions in FBM with a frequency of \u0026ge; 4 days/week (MD = -1.78, 95% CI: -3.46 to -0.01, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%) and in participants aged \u0026lt; 40 years (MD = -1.84, 95% CI: -3.66 to -0.02, \u003cem\u003ep\u003c/em\u003e = 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), but not with a frequency of \u0026lt; 4 days/week (MD = -0.09, 95% CI: -2.47 to 2.30, \u003cem\u003ep\u003c/em\u003e = 0.95, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%) or in participants aged \u0026ge; 40 years (MD = -0.43, 95% CI: -2.50 to 1.64, \u003cem\u003ep\u003c/em\u003e = 0.69, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMetabolic health\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe meta-analysis summary on metabolic health indicators is displayed in Table 2. Compared to normoxia, aerobic exercise training in hypoxia lead to larger reductions in TG (MD = -10.78, 95% CI: -20.68 to 0.88, \u003cem\u003ep\u003c/em\u003e = 0.05, \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 0%, Figure 6), LDL-C (MD = -5.28, 95% CI: -8.75 to -1.81, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 0%, Figure 7), and HOMA-IR (MD = -0.22, 95% CI: -0.33 to -0.11, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 0%, Figure 8). No significant differences were observed for TC, HDL-C, LDL, HDL, blood glucose and insulin between the two conditions (all \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e---------------------------insert Figure 6-8 about here------------------------\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the subgroup analysis are presented in Table 3. Larger reductions in TG were reported after aerobic exercise training in hypoxia compared to normoxia in subgroups with a duration of \u0026lt; 8 weeks (MD = -11.78, 95% CI: -22.16 to -1.40, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), session length of \u0026ge; 60 min (MD = -10.80, 95% CI: -20.85 to 0.70, \u003cem\u003ep\u003c/em\u003e = 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), FiO₂ \u0026ge; 15% (MD = -12.75, 95% CI: -23.02 to -2.49, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%). However, no significant effects were found in other subgroups (all\u003cem\u003e\u0026nbsp;p\u003c/em\u003e \u0026gt; 0.05) (Table 4). For LDL-C, aerobic exercise training in hypoxia induced larger effects than normoxia in subgroups with a frequency of \u0026ge; 4 days/week (MD = -5.28, 95% CI: -8.75 to -1.82, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), FiO₂ \u0026ge; 15% (MD = -5.34, 95% CI: -8.88 to -1.79, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%), and age \u0026lt; 40 years (MD = -5.47, 95% CI: -9.01 to -1.92, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003eI\u0026sup2;\u003c/em\u003e = 0%). No significant differences were reported in the other subgroups (Table 3).\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis meta-analysis is the first to compare the independent (not combined with other exercise forms) effects of aerobic exercise training interventions in hypoxia \u003cem\u003eversus\u003c/em\u003e normoxia on body composition and metabolic health in overweight and/or obese individuals. Our results indicate that training in hypoxia is more effective than in normoxia for reducing BM, FBM, TG, LDL-C and HOMA-IR. These findings highlight the benefits of aerobic exercise training in hypoxia, supporting its potential as an effective intervention for obesity management.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Body composition outcomes\u003c/h2\u003e \u003cp\u003eOur results indicate that aerobic exercise training in hypoxia leads to a greater reduction in BM compared to normoxia in overweight and/or obese individuals (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Typically, BM loss results from reductions in FBM, LBM, or both [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Given the similar benefits observed on LBM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71) and other body composition indicators (BMI, LBM, WC, HC, WHR, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.15\u0026ndash;0.92) between the two conditions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), it can be speculated that the larger BM reduction is primarily due to a trend towards larger FBM loss (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.08). This is consistent with a meta-analysis by He et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which demonstrated that exercise training in hypoxia more effectively reduces FBM than in normoxia in middle-aged and older adults. Several physiological mechanisms may explain the enhanced fat loss with hypoxic aerobic exercise. First, aerobic exercise training in hypoxia may increase metabolic rate and energy expenditure by stimulating GLUT-4 glucose transport and enhancing mitochondrial quantity and efficiency [\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which may reduce fat accumulation. Second, hypoxic exposure may stimulate leptin secretion while lowering acylated ghrelin levels [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], thereby suppressing appetite and reducing calorie intake. The reduction in calorie intake contributes to a larger energy deficit, which is critical for effective obesity management [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Third, the synergistic effects of hypoxic exposure and exercise may enhance post-exercise fat oxidation, leading to greater FBM loss compared to normoxia [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA previous meta-analysis that included various exercise modalities (e.g., resistance, high-intensity interval, and aerobic exercise) showed no greater reduction in FBM with hypoxic exercise compared to normoxia in overweight and/or obese individuals [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The discrepancy between their results and ours regarding FBM loss may stem from differences in the types of exercise modalities included (a combination of aerobic exercise, resistance exercise, and high-intensity interval training in [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] vs. aerobic exercise only in the present study). Recent studies suggest that aerobic exercise is more effective than resistance exercise and high-intensity interval training for reducing FBM in overweight and/or obese populations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. While high-intensity interval training and resistance exercise primarily promote hormone secretion (e.g., catecholamines and growth hormone) and increase LBM [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], aerobic exercise mainly targets fat mass reduction [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. However, there is currently no direct evidence comparing the effects of different exercise modalities on FBM reduction in hypoxia, which warrants further research.\u003c/p\u003e \u003cp\u003eOur subgroup analysis showed that, compared to normoxia, aerobic exercise training in hypoxia led to a greater reduction in FBM for individuals aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years, while no such effect was observed in those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, a meta-analysis by Ramos-Campo et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which included various exercise modalities, failed to report larger reduction in FBM with hypoxic exercise training over normoxia in overweight and/or obese individuals aged 14\u0026ndash;57 years. In addition to the influence of mixed exercise types discussed earlier, these divergent findings may also stem from the confounding factor of age. In their meta-analysis, approximately half of the participants were over 40 years old [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Research has demonstrated that aging is associated with a decline in both daily physical activity and basal metabolic rate [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], which may reduce energy expenditure and limit the effectiveness of hypoxic exercise interventions. Overall, compared to normoxia, aerobic exercise training in hypoxia results in larger reductions in FBM and BM in overweight and/or obese individuals, particularly those aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years, suggesting its potential for improving body composition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Metabolic health outcomes\u003c/h2\u003e \u003cp\u003eAerobic exercise training in hypoxia resulted in a greater reduction in TG compared to normoxia in overweight and/or obese individuals (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). This is consistent with a previous meta-analysis, which found that hypoxic exercise training led to a greater decrease in TG in this population [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We also observed a larger reduction in LDL-C following aerobic exercise training in hypoxia. These findings further support previous research suggesting that hypoxic aerobic exercise can alleviate dyslipidemia and maintain lipid metabolic health [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Among all the studies included in our meta-analysis, the only difference between the normoxia and hypoxia groups was exposure to a hypoxic environment during exercise. Consequently, the observed improvements in lipid metabolism can be predominantly attributed to hypoxic exposure. The underlying mechanisms are likely related to the activation of HIF triggered by hypoxic exposure [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Specifically, HIF upregulates peroxisome proliferator-activated receptor gamma and peroxisome proliferator-activated receptor coactivator 1, both of which play key roles in improving lipid metabolism [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Additionally, HIF improves O\u003csub\u003e2\u003c/sub\u003e transport efficiency [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] by stimulating erythropoietin and nitric oxide secretion [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], thereby improving fatty acid oxidation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that insulin resistance is a common complication in obese populations [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], our meta-analysis is the first to examine the effects of hypoxic intervention on insulin resistance by including the HOMA-IR index. Our results reveal that aerobic exercise training in hypoxia leads to a greater reduction in HOMA-IR (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). This may be due to hypoxic conditions alleviating insulin resistance by improving insulin sensitivity, which in turn helps maintain healthy glucose metabolism [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, we found no significant difference in insulin and blood glucose reduction between hypoxia and normoxia when aerobic exercise training was performed at similar relative intensities (with lower absolute intensity in hypoxia) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This aligns with a previous meta-analysis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], suggesting that hypoxic interventions may provide similar benefits for glucose metabolism as normoxia, yet at a lower absolute intensity [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Furthermore, no significant differences were observed in LDL and HDL reductions between hypoxia and normoxia following aerobic training (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This may be due to differences in exercise intensity. Previous studies have suggested that high exercise intensities (\u0026gt;\u0026thinsp;65% V̇O\u003csub\u003e2max\u003c/sub\u003e or \u0026gt;\u0026thinsp;65% HRR or \u0026gt;\u0026thinsp;75% HR\u003csub\u003emax\u003c/sub\u003e) are required to meaningfully improve HDL and LDL levels [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, 56]. Most studies included in our meta-analyses utilized moderate-intensity (45\u0026ndash;65% V̇O\u003csub\u003e2max\u003c/sub\u003e or 50\u0026ndash;65% HRR or 65\u0026ndash;75% HR\u003csub\u003emax\u003c/sub\u003e) exercise protocols, which may not have been sufficient to effectively reduce HDL and LDL levels in either hypoxic or normoxic conditions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Subgroup analysis\u003c/h2\u003e \u003cp\u003e \u003cem\u003eHypoxia severity\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOur findings indicate that FiO₂ \u0026ge; 15% more effectively reduces TG and LDL-C compared to FiO₂ \u0026lt; 15%, resulting in greater benefits for lipid metabolism (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Previous studies have indicated that total work and absolute intensity of exercise are key factors in improving lipid metabolism [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, more severe hypoxic conditions may provide a stronger hypoxic stimulus [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], potentially reducing participants' total work and limiting the physiological benefits of aerobic exercise training in hypoxia for overweight and/or obese populations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eFrequency, session length, and training duration\u003c/em\u003e \u003c/p\u003e \u003cp\u003eCompared to normoxia, aerobic exercise training in hypoxia with a duration of \u0026lt;\u0026thinsp;8 weeks, frequency of \u0026ge;\u0026thinsp;4 days/week, and session length of \u0026ge;\u0026thinsp;60 min resulted in larger reductions in BM, FBM, TG and LDL-C, effects not seen in other subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Consistent with our results, other meta-analysis has reported that prolonged hypoxic exposure and longer session can significantly reduce FBM and BM [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, a hypoxic intervention strategy involving moderate hypoxic exposure (FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;15%) with sessions lasting\u0026thinsp;\u0026ge;\u0026thinsp;60 min, a frequency of \u0026ge;\u0026thinsp;4 days/week, and a training duration of \u0026lt;\u0026thinsp;8 weeks appears to be effective for managing obesity.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAge\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSubgroup analysis revealed that aerobic exercise training in hypoxia was more effective in improving FBM, TG, and LDL-C in overweight and/or obese individuals aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years compared to those aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This may be attributed to younger individuals having higher levels of hormones (e.g., growth hormone and testosterone) which promote fat mobilization and utilization while inhibiting fat synthesis, thereby leading to greater benefits from hypoxia exposure [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Practical Implications","content":"\u003cp\u003eBased on our results and the characteristics of the included studies, an effective hypoxic intervention strategy for overweight and/or obese individuals would involve a FiO\u003csub\u003e2\u003c/sub\u003e of 15.0-16.5%, a training duration of 3\u0026ndash;8 weeks, a frequency of 4\u0026ndash;5 days/week, and session lengths of 60\u0026ndash;90 min. Furthermore, we recommend that practitioners consider the individual\u0026rsquo;s age and carefully control their circadian rhythms and energy intake both before and after training to develop a more comprehensive intervention strategy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This approach will help to maximize energy expenditure and reduce energy intake, thereby leading to more effective obesity management.\u003c/p\u003e"},{"header":"6. Limitations and Future Directions","content":"\u003cp\u003eThis study has several limitations. First, most of the included studies employed moderate-intensity aerobic exercise training in hypoxia, so our meta-analysis did not examine the effects of aerobic exercise at varying intensities. It remains unclear whether higher exercise intensities would provide additional physiological benefits. Second, due to the lack of studies focusing on females only, our meta-analysis did not explore the impact of sex on the effects of hypoxic interventions. Evidence suggests that females tend to have higher fat reserves and a greater capacity to mobilize free fatty acids, which may modulate the effects of hypoxic interventions [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Lastly, some studies have reported that combined exercise modalities (e.g., aerobic exercise with resistance training) lead to larger improvements in body composition and metabolic health compared to aerobic exercise alone [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Future research should determine the most effective exercise modalities and consider the impact of potential factors (e.g., sex and exercise intensity). This would help develop more personalized, effective, and systematic intervention strategies tailored to individual characteristics.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eAerobic exercise training in hypoxia is more effective than in normoxia for reducing body mass, fat body mass, triglycerides, and low-density lipoprotein cholesterol in overweight and/or obese individuals. These findings could inform the development of effective hypoxic exercise interventions for managing obesity, as this approach gains popularity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ebody mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ebody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003econfidence intervals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eFBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003efat body mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003einspired oxygen fraction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eLBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003elean body mass\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ehip circumference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eHDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ehigh-density lipoprotein cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eHOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ehomeostasis model assessment index of insulin resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ehigh-density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003elow-density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eLDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003elow-density lipoprotein cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003emean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003eoxygen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003estandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eSEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003estandard error of mean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003etotal cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003etriglycerides\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eWC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ewaist circumference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eWHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003ewaist-to-hip ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.4848%;\"\u003e\n \u003cp\u003eV̇O\u003csub\u003e2max\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71.5152%;\"\u003e\n \u003cp\u003emaximal oxygen uptake\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely appreciate the participants for their valuable time and diligent effort in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.C. and L.D. conceived and designed research. L.D. and J.H. contributed to data collection. L.D., J.H. and B.C. performed data analysis. J.L., L.D., L.G., and Y.C. interpreted the experimental results. L.D. and J.H. prepared figures. J.H. and L.D. drafted manuscript. L.D., J.H., J.L., B.C., L.G., O.G. and Y.C. edited and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Shanghai Key Laboratory of Human Performance at Shanghai University of Sport (grant number: 11DZ2261100).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e School of Athletic Performance, Shanghai University of Sport, Shanghai, China. \u003csup\u003e2\u003c/sup\u003e Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China. \u003csup\u003e3\u003c/sup\u003e School of Exercise and Health, Shanghai University of Sport, Shanghai, China. \u003csup\u003e4\u003c/sup\u003e Department of Public Physical Education, Fujian Agriculture and Forestry University, Fuzhou, China. \u003csup\u003e5\u003c/sup\u003e School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eACSM. ACSM\u0026rsquo;s Guidelines for Exercise Testing and Prescription. 10th ed. Philadelphia: Wolters Kluwer Health; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen X, He H, Xie K, Zhang L, Cao C. Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta-analysis of 84 randomized controlled trials. Obes Rev. 2024;25(3):e13666.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Donoghue G, Blake C, Cunningham C, Lennon O, Perrotta C. What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta-analysis. 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Mandibular growth retardation in growing rats chronically exposed to hypobaria. J Dent Res. 1987;66(1):65\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly LP, Basset FA. Acute Normobaric Hypoxia Increases Post-exercise Lipid Oxidation in Healthy Males. Front Physiol. 2017;8:293.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeidleman BA, Rock PB, Muza SR, Fulco CS, Gibson LL, Kamimori GH, et al. Substrate oxidation is altered in women during exercise upon acute altitude exposure. Med Sci Sports Exerc. 2002;34(3):430\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffiths A, Shannon OM, Matu J, King R, Deighton K, O'Hara JP. The effects of environmental hypoxia on substrate utilisation during exercise: a meta-analysis. J Int Soc Sports Nutr. 2019;16(1):10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Characteristics of the included studies\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1002\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 66px;\"\u003e\n \u003cp\u003eStudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 350px;\"\u003e\n \u003cp\u003eparticipants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 397px;\"\u003e\n \u003cp\u003e Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSample size (M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 128px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003eDuration (week)/Frequency (days/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eExercise protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003eType and severity of hypoxia \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePattern and duration of hypoxic exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eHYP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eNOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eHYP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eNOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eHYP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eNOR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eNetzer et al. [37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10 (2/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e10 (2/8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e50.1 \u0026plusmn; 13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e45.5 \u0026plusmn; 13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.4 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.8 \u0026plusmn; 3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e90 min of stepper, treadmill,\u0026nbsp;bicycle ergometer at 60% HR\u003csub\u003emax\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 90 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, TG, HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eHaufe et al. [35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10 (10/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e10 (10/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e29.0 \u0026plusmn; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e28.1 \u0026plusmn; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e25.1 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e24.0 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of running at 3 mmol/L lactate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, TG, LDL, HDL, HOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eWiesner et al. [13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e24 (10/14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e21 (8/13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e42.2 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e42.1 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.1 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.5 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of running at 65% V̇O\u003csub\u003e2max \u0026nbsp;\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eLBM, WC, LDL, SBP, DBP, Insulin, HOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eYang et al., [38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10 (10/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e8 (8/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e22.5 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e22.1 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e30.7 \u0026plusmn; 4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e28.4 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of cycling and running at 71-76% V̇O\u003csub\u003e2max\u0026nbsp;\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, FBM, TC, TG, LDL, HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eGatterer et al. [34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e16 (4/12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e16 (6/10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e50.3 \u0026plusmn; 10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e52.4 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e37.9 \u0026plusmn; 8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e36.3 \u0026plusmn; 4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e32/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e90 min of cycling, running and cross trainer at 65-70% HR\u003csub\u003emax\u003c/sub\u003e and rested for additional 90 min in normobaric hypoxic chambers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 14.0 \u0026plusmn; 0.2% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 180 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, FBM, WC, HC, WHR, TC, TG, HDL, Glucose, SBP, DBP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eZhao et al. [39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9 (9/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e9 (9/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e18.2 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e18.1 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32. 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31. 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of cycling at 65-75% V̇O\u003csub\u003e2max \u0026nbsp;\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 14.7% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, FBM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ePark et al. [40]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11 (0/11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e12 (0/12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e42.0 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e47.2 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of treadmill and bicycle at 75% HR\u003csub\u003emax\u0026nbsp;\u003c/sub\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 16.5% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, FBM, TC, LDL-C, HDL-C, SBP, DBP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eShin et al. [14]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8 (8/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e9 (9/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e45.6 \u0026plusmn; 20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e46.0 \u0026plusmn; 20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26.8 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27.0 \u0026plusmn; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e50 min of running in treadmill at 60% HR\u003csub\u003emax\u003c/sub\u003e, (5 min warm-up; 40 min main set and 5 min cold down)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 50 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, FBM, WC, TC, TG, LDL-C, HDL-C, HOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eklug et al. [36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12 (12/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e11 (11/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e55.0 \u0026plusmn; 7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e57.6 \u0026plusmn; 7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e35.5 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e34.1 \u0026plusmn; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of walking at 60% HR\u003csub\u003emax\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, LBM, FBM, WC, HC, WHR, TG, LDL, HDL, Glucose, Insulin, SBP, DBP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eFern\u0026aacute;ndez et al. [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12 (2/10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e11 (2/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e34.8 \u0026plusmn; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e32.2 \u0026plusmn; 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e34.0 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.9 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of walking at six different speeds\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 14.5% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, LBM, FBM, TC, TG, LDL-C, HDL-C, Insulin, HOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eZhang et al. [23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e20 (20/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e20 (20/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e22.3 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e21.9 \u0026plusmn; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.8 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.3 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e60 min of cycling at 65% V̇O\u003csub\u003e2max \u0026nbsp;\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 60 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, FBM, TC, TG, LDL-C, HDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003echacaroun et al., [24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12 (11/1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e11 (8/3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e52.0 \u0026plusmn; 12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e56.0 \u0026plusmn; 11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.2 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.8 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e45 min of cycling at 75 \u0026plusmn; 2% HR\u003csub\u003emax\u0026nbsp;\u003c/sub\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 13.0% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 45 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBMI, LBM, FBM, WC, HC, TC, TG, LDL, HDL, Insulin, SBP, DBP, HOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eNamboonlue et al. [25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10 (10/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e10 (10/0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e20.3 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e19.8 \u0026plusmn; 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26.3 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27.0 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e30 min of running at 60% HRR (5 min warm-up; 20 min main set and 5 min cold down)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNormobaric,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e = 15.8% \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003eIntermittent, 30 min/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eBM, BMI, LBM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eM: male; F: female; NA: no available; FiO\u003csub\u003e2\u003c/sub\u003e: inspired fraction of oxygen; HR\u003csub\u003emax\u003c/sub\u003e: maximum heart rate;\u0026nbsp;V̇O\u003csub\u003e2max\u003c/sub\u003e: maximal oxygen consumption; HRR: heart rate reserve; BM: body mass; BMI: body mass index; LBM: lean body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; \u0026nbsp; LDL-C: low-density lipoprotein cholesterol; HDL-C: high density lipoprotein cholesterol; LDL: low density lipoprotein; HDL: high density liporotein; Intermittent: hypoxic training consisting of hypoxia exposure lasting seconds to hours with a return to normoxia or lower levels of hypoxia and repetition over days to weeks.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"82%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 770px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eSummary of meta-analyses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eIndices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003eMean difference (95% of CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eI\u003c/em\u003e2\u0026nbsp;(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eBias\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 85px;\"\u003e\n \u003cp\u003eBody Composition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.90 (-1.80, -0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.30; Begg: \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.57 (1.35, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.88; Begg: \u003cem\u003ep\u003c/em\u003e = 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eLBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e0.71 (-3.09, 4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.49; Begg: \u003cem\u003ep\u003c/em\u003e = 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eFBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.22 (-2.59, 0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.09; Begg: \u003cem\u003ep\u003c/em\u003e = 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eWC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.52 (-3.95, 2.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.52; Begg: \u003cem\u003ep\u003c/em\u003e = 0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.22 (-4.41, 3.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.59; Begg: \u003cem\u003ep\u003c/em\u003e = 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eWHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.00 (-0.05, 0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMetabolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.51 (-9.82, 6.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.5% (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.43; Begg: \u003cem\u003ep\u003c/em\u003e = 0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-10.78 (-20.68, -0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.98; Begg: \u003cem\u003ep\u003c/em\u003e = 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.65 (9.19, 5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e70% (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.96; Begg: \u003cem\u003ep\u003c/em\u003e = 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eLDL-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-5.28 (-8.75, -1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.41; Begg: \u003cem\u003ep\u003c/em\u003e = 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e4.31 (3.61, 12.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.04; Begg: \u003cem\u003ep\u003c/em\u003e = 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHDL\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.68 (6.99, 3.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.60; Begg: \u003cem\u003ep\u003c/em\u003e = 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eGlucose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.74 (-16.24, 12.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.31; Begg: \u003cem\u003ep\u003c/em\u003e = 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eInsulin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e0.62 (-1.66, 2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.70; Begg: \u003cem\u003ep\u003c/em\u003e = 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eHOMA-IR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.22 (-0.33, -0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0% (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003eEgger: \u003cem\u003ep\u003c/em\u003e = 0.40; Begg: \u003cem\u003ep\u003c/em\u003e = 0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBM: body mass; BMI: body mass index; LBM: lean body mass; FBM: fat body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance. Bold text signifes statistically signifcant results.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Summary of subgroup analyses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eMean difference (95% of CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eBM\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.94 (-2.26, 0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.87 (-2.09, 0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.85 (-1.77, 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.00 (-6.29, 2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.27 (-4.98, 0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.73 (-1.68, 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.89 (-1.80, 0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.25 (-7.55, 5.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.30 (-3.36, 0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.2% (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.73 (-1.90, 0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eBMI\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.08 (-1.40, 1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.86 (-1.88, 0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.20 (-1.33, 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.85 (-1.75, 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.46 (-1.63, 2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.24 (-1.09, 0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.74 (-1.58, 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.05 (-1.46, 1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.46 (-1.63, 2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.74 (-1.58, 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eLBM\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.29 (-5.43, 6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.05 (-4.03, 6.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.95 (-4.87, 6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.54 (-4.48, 5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eFBM\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.43 (-2.50, 1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.84 (-3.66, -0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.54 (-3.55, 0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.95 (-2.82, 0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.78 (-3.46, -0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.09 (-2.47, 2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.24 (-2.70, 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.06 (-5.08, 2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.99 (-4.73, 0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.97 (-2.55, 0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eWC\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.20 (-4.55, 4.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.05 (-6.63, 4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.26 (-6.04, 3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.27 (-4.66, 5.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eTC\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e9.75 (-2.95, 22.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-9.87 (-20.74,1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-7.93 (-18.58, 2.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e8.02 (-5.06, 21.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.82 (-16.74,11.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e33.4% (0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e5.61 (-9.94, 21.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.01 (-11.48, 11.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e28.5% (0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.73 (-24.62, 26.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e9.93 (-0.48, 20.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eDuration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-4.11 (-13.23, 5.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eTG\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-8.56 (-37.83, 20.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-10.93 (-20.78, -1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8.1% (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-13.28(-23.49, -3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15\u0026nbsp;%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e20.98 (-16.60, 58.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-20.95 (-61.42, 19.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e27.1% (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-6.00 (-23.31, 11.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-10.80(-20.85, -0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-22.68 (-94.91, 49.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e31.6% (0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eTraining duration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.38 (-36.04, 31.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e12.4% (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eTraining duration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-11.78 (-22.16, -1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eLDL-C\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.12 (-17.94, 15.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-5.47 (-9.01, -1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-5.34 (-8.88, -1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-3.93 (-21.11, 13.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-5.28 (-8 75, -1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-3.27 (-24.49, 17.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eHDL-C\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e2.79 (-2.06, 7.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-7.67 (-21.55, 6.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e76.1% (0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-3.98 (-16.79, 8.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e79.1% (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e2.40 (-3.42, 8.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency:\u0026nbsp;\u0026ge; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.79 (-13.51, 7.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e69.6% (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFrequency: \u0026lt; 4 days/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.74 (-8.94, 10.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eLDL\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.79 (-22.23, 23.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e4.31 (-3.61, 12.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eHDL\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-1.42 (-7.83, 4.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e14.9% (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-3.09 (-17.01, 10.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8.2% (0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.61 (-7.51, 6.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-3.69 (-14.80, 7.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e42.6% (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eTrainin g duration:\u0026nbsp;\u0026ge; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.53 (-10.19, 9.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e40.8% (0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eTraining duration:\u0026nbsp;\u0026lt; 8 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-2.85 (-10.59, 4.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eInsulin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.23 (-3.62, 4.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9.4% (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.03 (-2.28, 4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9.5% (0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.26 (-3.17, 3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9.1% (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.19 (-2.46, 4.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.7% (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.37 (-1.47, 4.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.74 (-4.55, 3.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cem\u003eHOMA-IR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026ge; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.04 (-0.59, 0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eAge: \u0026lt; 40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.19 (-0.41, 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e11.7% (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026ge; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.24 (-0.35, -0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e:\u0026nbsp;\u0026lt; 15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.14 (-0.33, 0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026ge; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.19 (-0.41, 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e11.7% (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSession length: \u0026lt; 60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-0.04 (-0.59, 0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0% (0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFiO\u003csub\u003e2\u003c/sub\u003e: inspired fraction of oxygen; BM: body mass; BMI: body mass index; LBM: lean body mass; FBM: fat body mass; WC: waist circumference; HC: hip circumference; WHR: waist-to-hip ratio; TC: total cholesterol; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high- density lipoprotein cholesterol; LDL: low-density lipoprotein; HDL: high-density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance. Bold text signifes statistically signifcant results.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aerobic training, hypoxia, body composition, metabolic health, obesity","lastPublishedDoi":"10.21203/rs.3.rs-5556421/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5556421/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhile aerobic training is well-established for improving body composition and metabolic health in normoxia, its effectiveness in hypoxia remains unclear.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis meta-analysis examines whether aerobic training in hypoxia is more effective than in normoxia for improving body composition and metabolic health in overweight and/or obese individuals, and identifies optimal exercise prescription variables.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA search of five databases was conducted through 10 November 2024. Random-effects meta-analyses evaluated body composition (e.g., body mass and fat mass) and metabolic health markers (e.g., triglycerides and glucose). Subgroup analyses were performed based on inspired oxygen fraction (FiO\u003csub\u003e2\u003c/sub\u003e), exercise duration, frequency, session length, and age.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAerobic training in hypoxia resulted in greater reductions in body mass (mean difference [MD] = -0.90, 95% confidence interval [CI]: -1.80 to -0.01), triglycerides (MD = -10.78, 95% CI: -20.68 to -0.88), low-density lipoprotein cholesterol (MD = -5.28, 95% CI: -8.75 to -1.81), and insulin resistance (MD = -0.22, 95% CI: -0.33 to -0.11) (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a trend towards larger fat mass loss (MD = -1.22, 95% CI: -2.59 to 0.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.08). These benefits were more prominent in moderate hypoxia (FiO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026ge;\u0026thinsp;15%), in individuals\u0026thinsp;\u0026lt;\u0026thinsp;40 years, and with protocols involving\u0026thinsp;\u0026ge;\u0026thinsp;4 days/week, \u0026ge; 60-min sessions, and \u0026lt;\u0026thinsp;8 weeks of training.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAerobic training in hypoxia is more effective than in normoxia for reducing body mass, fat mass, triglycerides, low-density lipoprotein cholesterol, and insulin resistance in overweight and/or obese individuals. These findings could help inform obesity management strategies using hypoxic training.\u003c/p\u003e","manuscriptTitle":"Effects of Aerobic Exercise Training in Hypoxia versus Normoxia on Body Composition and Metabolic Health in Overweight and/or Obese Population: An updated Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-06 04:23:30","doi":"10.21203/rs.3.rs-5556421/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revision","date":"2025-06-22T07:52:08+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-01-07T07:37:30+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-03T14:23:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-02T12:18:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sports Medicine-Open","date":"2024-11-30T20:55:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9c479ad-8ee6-497f-b210-ba401ec2773f","owner":[],"postedDate":"January 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T15:59:11+00:00","versionOfRecord":{"articleIdentity":"rs-5556421","link":"https://doi.org/10.1186/s40798-025-00918-6","journal":{"identity":"sports-medicine-open","isVorOnly":false,"title":"Sports Medicine-Open"},"publishedOn":"2025-10-01 15:56:58","publishedOnDateReadable":"October 1st, 2025"},"versionCreatedAt":"2025-01-06 04:23:30","video":"","vorDoi":"10.1186/s40798-025-00918-6","vorDoiUrl":"https://doi.org/10.1186/s40798-025-00918-6","workflowStages":[]},"version":"v1","identity":"rs-5556421","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5556421","identity":"rs-5556421","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}