Multicomponent Weight Management Versus Structured Aerobic Exercise in Postgraduate Students

Study design and participants This single-centre, two-arm, parallel exploratory randomized trial was conducted at Hainan Normal University, China. Forty-eight postgraduate students were randomized in a 1:1 ratio. Participants met at least one of the following excess-adiposity criteria: BMI of at least 24 kg/m²; WC of at least 85 cm in men or 80 cm in women; or BFP of at least 20% in men or 25% in women. The intervention period reported in the manuscript was eight weeks.

Multicomponent intervention The intervention combined aerobic, resistance, and flexibility exercise with individualized nutritional and behavioural support. WC and BFP were cross-classified into nine categories.

WC categories were below 85, 85 to below 90, and at least 90 cm in men, and below 80, 80 to below 85, and at least 85 cm in women. BFP categories were below 20%, 20% to below 25%, and at least 25% in men, and below 25%, 25% to below 30%, and at least 30% in women.

At two-week reassessments, WC and BFP were reclassified jointly using the same sex-specific cutoffs. Participants whose measurements placed them in a different cell were assigned the prescription associated with that cell. When the two measures changed in opposite directions, the newly observed cross-classification determined the cell assignment. Reassessment within the same cell did not itself constitute a category change. These categories organized the intervention; their independent clinical utility was not tested by this randomized comparison.

Active comparator The comparator was an eight-week structured aerobic exercise programme, primarily involving brisk walking, jogging, or cycling. The programme prescribed 3-5 sessions per week and a weekly aerobic-duration target exceeding 150 minutes. Sessions included a 5-minute warm-up, 25-40 minutes of core aerobic exercise, and a 15-minute cool-down.

Core intensity was prescribed at 40%-50% of heart rate reserve during weeks 1-2, 50%-70% during weeks 3-6, and 60%-80% during weeks 7-8. Exercise load could be adjusted for fatigue or reduced tolerance. The comparator did not use WC-BFP categories to assign management tiers or guide prescription changes.

Shared support and monitoring Both groups received individualized daily energy-intake targets intended to create an energy deficit according to individual circumstances, Huawei Band 9 monitoring, daily online exercise and dietary logging, and remote supervision. Dietary records were submitted for staff review. Prescribed dietary and exercise targets were distinguished from achieved intake and exercise exposure.

Outcome assessments Body weight and BFP were measured using a bioelectrical impedance device. BMI was calculated as weight in kilograms divided by height in metres squared. WC and hip circumference were measured using a standardized anthropometric procedure, and waist-to-hip ratio was calculated as WC divided by hip circumference.

Exercise self-efficacy was assessed using the Chinese version of the Self-Efficacy for Exercise Scale. Self-reported adherence was assessed using Section B of the Exercise Adherence Rating Scale. Anthropometric outcomes and self-efficacy were assessed at baseline and weeks 4 and 8; adherence was assessed at weeks 4 and 8, without a baseline adherence assessment.

Analysis of observed outcomes The observed-outcome analyses used mixed models for repeated measures and included all valid follow-up measurements under the original randomized assignment. Anthropometric outcomes and exercise self-efficacy were adjusted for their respective baseline values. No baseline adherence covariate was included because adherence was not assessed at baseline. Valid scheduled measurements obtained after discontinuation of the intervention were retained. Intervention discontinuation and availability of outcome measurements were treated as separate statuses.

The eight week-8 between-group comparisons comprised body weight, BMI, BFP, WC, hip circumference, waist-to-hip ratio, exercise self-efficacy, and self-reported exercise adherence. Holm adjustment was applied across this family of eight comparisons. Effect estimates were reported with nominal 95% confidence intervals.

Missing-data and covariate sensitivity analyses Missing-data sensitivity analyses retained the 48-participant randomized framework. Under a missing-at-random assumption, multiple imputation used 50 completed datasets and 20 fully conditional specification iterations. Direct anthropometric measurements used normal linear regression imputation, and questionnaire scores used predictive mean matching. Predictors included randomized group, sex, the applicable baseline measurement, and the other follow-up measurement. WC, hip circumference, and missing waist-to-hip ratio values used the same jointly completed WC and hip-circumference components. Observed measurements were retained without replacement.

Additional analyses examined departures from the missing-at-random assumption for body weight, adjustment for sex across all eight week-8 outcomes, and additional adjustment for baseline BFP in the body-weight analysis. These analyses were conducted during manuscript revision and should not be interpreted as prospectively registered analyses.

Interpretation of the comparison The randomized contrast compared an integrated intervention package with an active aerobic comparator under shared dietary-target and digital-monitoring conditions. The packages differed in exercise modalities and individualized management components. The trial therefore cannot attribute any between-group difference specifically to phenotype matching or separate its contribution from exercise dose, nutrition, behavioural support, or professional contact.

Registration and outcome specification The record was first submitted to ClinicalTrials.gov on August 10, 2025 and first posted on August 21, 2025, after the currently recorded study completion date. Registration was retrospective. The current registration lists BMI and body weight as primary outcomes, whereas the manuscript emphasizes week-8 body weight. Subsequent registry corrections and analyses conducted during manuscript revision do not establish prospective specification of the outcome hierarchy.