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Original Investigation
July 3, 2019

Effect of Aerobic and Resistance Exercise on Cardiac Adipose Tissues: Secondary Analyses From a Randomized Clinical Trial

Author Affiliations
  • 1The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  • 2Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
  • 3Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  • 4Department of Rheumatology, Institute of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
  • 5Department of Cardiology, Copenhagen University Hospital Bispebjerg, Capital Region of Copenhagen, Copenhagen, Denmark
JAMA Cardiol. 2019;4(8):778-787. doi:10.1001/jamacardio.2019.2074
Key Points

Question  Are epicardial and pericardial adipose tissues regulated by both endurance and resistance training?

Findings  In this secondary analysis of a randomized clinical trial including 50 individuals with abdominal obesity, endurance and resistance training significantly reduced epicardial adipose tissue mass by 32% and 24%, respectively. While resistance training reduced pericardial adipose tissue mass by 32%, there was no effect of endurance training on pericardial adipose tissue.

Meaning  Endurance and resistance training have the potential to reduce cardiac adipose tissue mass and may have clinical potential given that excessive cardiac adipose tissue is associated with an increased incidence of cardiovascular disease.


Importance  Epicardial and pericardial adipose tissues are emerging as important risk factors for cardiovascular disease, and there is a growing interest in discovering strategies to reduce the accumulation of fat in these depots.

Objective  To investigate whether a 12-week endurance or resistance training intervention regulates epicardial and pericardial adipose tissue mass.

Design, Setting, and Participants  Secondary analysis of a randomized, assessor-blinded clinical trial initiated on August 2016 and completed April 2018. This single-center, community-based study included 50 physically inactive participants with abdominal obesity.

Interventions  Participants were randomized to a supervised high-intensity interval endurance training (3 times a week for 45 minutes), resistance training (3 times a week for 45 minutes), or no exercise (control group).

Main Outcomes and Measures  Change in epicardial and pericardial adipose tissue mass assessed by magnetic resonance imaging, based on a prespecified secondary analysis plan including 3 of 5 parallel groups.

Results  Of 50 participants (mean [SD] age, 41 [14] years, 10 men [26%]; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 32 [5]), 39 [78%] completed the study. Endurance training and resistance training reduced epicardial adipose tissue mass by 32% (95% CI, 10%-53%) and 24% (95% CI, 1%-46%), respectively, compared with the no exercise control group (56% [95% CI, 24%-88%]; P = .001 and 48% [95% CI, 15%-81%]; P < .001, respectively). While there was a nonsignificant reduction in pericardial adipose tissue mass after endurance training (11% [95% CI, −5% to 27%]; P = .17), resistance training significantly reduced pericardial adipose tissue mass by 31% (95% CI, 16%-47%; P < .001) when compared with the no exercise control group. Compared with the no exercise control group, there was an increase in left ventricular mass by endurance (20 g [95% CI, 11%-30%]; P < .001) and resistance training (18 g [95% CI, 8%-28%]; P < .001). Other cardiometabolic outcomes remained unchanged after the 12-week trial period.

Conclusions and Relevance  In individuals with abdominal obesity, both endurance and resistance training reduced epicardial adipose tissue mass, while only resistance training reduced pericardial adipose tissue mass. These data highlight the potential preventive importance of different exercise modalities as means to reduce cardiac fat in individuals with abdominal obesity.

Trial Registration  ClinicalTrials.gov identifier: NCT02901496