INS and obesity due to melanocortin 4 receptor deficiency: Six studies reported that physical activity, independent of weight loss, resulted in positive changes in whole body metabolic and cardiovascular outcomes and related biomarkers in people with obesity, including reductions in serum triglycerides and decreased arterial stiffness [23,27,28], increased mitochondrial respiration [25], increased fat oxidation and insulin sensitivity [19] and decreases in both liver fat and HbA1C [26].