Open Access Highly Accessed Study protocol

Nutrition and physical activity programs for obesity treatment (PRONAF study): methodological approach of the project

Augusto G Zapico128*, Pedro J Benito1, Marcela González-Gross1, Ana B Peinado1, Esther Morencos1, Blanca Romero1, Miguel A Rojo-Tirado1, Rocio Cupeiro13, Barbara Szendrei1, Javier Butragueño1, Maite Bermejo1, María Alvarez-Sánchez45, Miguel García-Fuentes6, Carmen Gómez-Candela7, Laura M Bermejo7, Ceila Fernandez-Fernandez7 and Francisco J Calderón1

Author Affiliations

1 Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Technical University of Madrid, C/Martín Fierro 7, Madrid, 28040, Spain

2 Department of Physical Education, School of Education, Complutense University of Madrid, C/Rector Royo Villanova sn, Madrid, 28040, Spain

3 Francisco de Vitoria University, Ctra. Pozuelo-Majadahonda Km 1.800, Madrid, 28223, Spain

4 Institute of Veterinary Physiology, University of Zurich, Winterthurerstrasse 260, Zurich, 8057, Switzerland

5 Center for Integrative Human Physiology (ZIHP), Winterthurerstrasse 190, Zurich, 8057, Switzerland

6 Department of Medical and Surgery Sciences, School of Medicine-IFIMAV, Marqués de Valdecilla Research Institute, Cantabria University, Avda. Cardenal Herrera Oria sn, Santander, 39011, Spain

7 Nutrition Department, IdiPAZ, University Hospital La Paz Research Institute, Paseo de la Castellana 268, Madrid, 28043, Spain

8 Laboratorio de Fisiología de Esfuerzo, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, C/Martín Fierro 7, Madrid, 28040, Spain

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BMC Public Health 2012, 12:1100  doi:10.1186/1471-2458-12-1100

Published: 21 December 2012



At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study.


One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18–50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29–34% of the total energy intake came from fat, 14–20% from protein, and 50–55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%).


Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications.

Trial registration NCT01116856

Overweight; Obesity; Caloric restriction; Exercise; Weight loss