Time-restricted eating and exercise training improve HbA1c and body composition in women with overweight/obesity: A randomized controlled trial

Diet modification and exercise training are primary lifestyle strategies for obesity management, but poor adherence rates limit their effectiveness. Time-restricted eating (TRE) and high-intensity interval training (HIIT) improve cardiometabolic health in at-risk individuals, but whether these two interventions combined induce superior improvements in glycemic control than each individual intervention is not known. In this four-armed randomized controlled trial (ClinicalTrials.gov NCT04019860), we determined the isolated and combined effects of seven weeks of TRE (≤ 10-h ad libitum eating window every day) and HIIT (three exercise sessions per week), compared with a non-intervention control group, on glycemic control and secondary cardiometabolic outcomes in women with overweight/obesity. There were no statistically significant effects after isolated TRE, HIIT, or a combination (TREHIIT) on glucose area under the curve during an oral glucose tolerance test (the primary outcome) compared with the control group; TRE: -26.3 mmol/L, 95% confidence interval (CI): -82.3, 29.7 (p = .36), HIIT: -53.8 mmol/L, 95% CI: -109.2, 1.6 (p = .057), TREHIIT: -41.3 mmol/L, 95% CI: -96.4, 13.8 (p = .14). However, TREHIIT improved HbA1c and induced superior reductions in total and visceral fat mass compared with TRE and HIIT alone. High participant adherence rates suggest that TRE, HIIT, and a combination thereof, may be realistic diet-exercise strategies for improving markers of metabolic health in women at risk of cardiometabolic disease.饮食调整与运动训练是肥胖管理的核心生活方式干预策略，但受试者依从性欠佳往往会制约其干预效果。限时进食（Time-restricted eating, TRE）与高强度间歇训练（High-intensity interval training, HIIT）可改善高危人群的心脏代谢健康，但目前尚不明确两种干预手段联合应用时，能否比单一干预更有效地改善血糖控制情况。本研究为四臂随机对照试验（ClinicalTrials.gov 注册号：NCT04019860），旨在针对超重/肥胖女性群体，对比非干预对照组、7周限时进食（每日自由进食窗口≤10小时）、7周高强度间歇训练（每周3次训练）以及两种干预联合应用这四种方案，对血糖控制及次要心脏代谢结局的单独与联合效应。与对照组相比，单一限时进食、单一高强度间歇训练以及两种干预联合（TREHIIT）均未对口服葡萄糖耐量试验中的血糖曲线下面积（本研究主要结局指标）产生具有统计学意义的影响：限时进食组变化值为-26.3 mmol/L，95%置信区间（CI）为[-82.3, 29.7]（p=0.36）；高强度间歇训练组变化值为-53.8 mmol/L，95%置信区间为[-109.2, 1.6]（p=0.057）；联合干预组变化值为-41.3 mmol/L，95%置信区间为[-96.4, 13.8]（p=0.14）。但与单一限时进食或单一高强度间歇训练相比，联合干预方案可改善糖化血红蛋白（HbA1c）水平，并更有效地降低总体脂肪量与内脏脂肪量。受试者依从性较高，提示限时进食、高强度间歇训练及其联合方案，均可作为改善心脏代谢疾病高危女性代谢健康标志物的切实可行的饮食-运动干预策略。