In this systematic review of clinical trials performed to investigate a previously hypothesized dose-response effect of aerobic exercise on visceral (intra-abdominal) adipose tissue reduction, Ohkawara et al. selected 9 randomized control trials and 13 non-randomized control trials from the literature. One of the main findings of this paper is that such a dose-response effect exists, but only among participants without metabolic, visceral fat-related disorders such as insulin resistance, chronic inflammation, and/or dyslipidemia. To harmonize the discrepancy between visceral fat and energy expenditure quantification among selected publications, all visceral fat units were converted into percentage of visceral fat change per week (%∆VF/w) and energy expenditure units were converted into metabolic equivalents per hour per week (METs•h/w). Although the authors recognized that the studies included in this systematic review differed in terms of gender, duration time, the effect of diet, and the presence of metabolic-related disorders, they concluded that aerobic exercise was a powerful way to induce visceral fat loss, in some cases even without body weight loss. Another key finding of this systematic review is that a specific energy expenditure threshold is required for visceral fat reduction. The authors suggest that at least 10 METs•h/w is required for visceral fat loss and that this objective can be achieved via aerobic exercise such as brisk walking, light jogging, or the use of stationary ergometers.
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