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Recommendations For Prescribing Exercise To Overweight and Obese Patients

Overweight and obese patients should be prescribed at least 30 minutes of moderate intensity physical activity most days of the week to help maintain health and reduce disease risk. More activity may be needed to prevent weight gain or facilitate weight loss. Exercise prescriptions should follow the FITT framework of frequency, intensity, time and type of activity. Walking is generally a good activity but higher intensity or weight bearing exercise may not be suitable for some obese individuals. Medical screening may be required before exercise depending on a patient's health conditions and capabilities.

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0% found this document useful (0 votes)
123 views5 pages

Recommendations For Prescribing Exercise To Overweight and Obese Patients

Overweight and obese patients should be prescribed at least 30 minutes of moderate intensity physical activity most days of the week to help maintain health and reduce disease risk. More activity may be needed to prevent weight gain or facilitate weight loss. Exercise prescriptions should follow the FITT framework of frequency, intensity, time and type of activity. Walking is generally a good activity but higher intensity or weight bearing exercise may not be suitable for some obese individuals. Medical screening may be required before exercise depending on a patient's health conditions and capabilities.

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ashkenadaharsa
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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10

Recommendations for
Prescribing Exercise to
Overweight and
Obese Patients

10
Recommendations for Prescribing Exercise to
10 Overweight and Obese Patients

Effects of Exercise
The increasing prevalence of obesity reflects a lack of energy balance in a large number of
people who are consistently expending fewer calories than they consume. It is reasonable to
assume that persons with relatively high daily energy expenditures would be less likely to gain
weight over time, compared with those who have low energy expenditures.

Research has shown that adults are more likely to maintain a healthy weight if they have an
active lifestyle and reduce their physical inactivity (1-3). A systematic review of randomised
control trials (RCTs) in early postmenopausal women suggested that walking at least 30 mins
per day plus twice weekly resistance exercise sessions was likely to be effective in preserving
normal body weight (4). International consensus guidelines, based largely around data from
epidemiological prospective studies also recommended that adults should engage in 45 to
60 mins of moderate-intensity physical activity per day to prevent transition to overweight or
obesity (5). Currently, the specific types and amounts of activity required to prevent weight
gain have not been well established using prospective study designs, and it is best to assume
that the specific amount of physical activity that will help prevent unhealthy weight gain is
a function that differs between individuals, but that in general more activity increases the
probability of success (6).

Despite the intuitive appeal of the idea that physical activity helps in losing weight, physical
activity appears to produce only modest increments of weight loss beyond those achieved by
dietary measures and its effects no doubt vary among people (7). A meta-analysis of RCTs on
the effectiveness of physical activity for weight loss in obese individuals revealed physical activity
(minimum of 45 mins 3 times a week) combined with diet (600 kcal/deficit or low fat) results in
an approximate weight change of –1.95 kg (95% CI -3.22 to -0.68) (range –1.00 kg to –3.60
kg) compared to diet alone at 12 months (1). Whilst the addition of physical activity on top of
a dietary intervention enhanced weight loss, physical activity appeared to be less effective than
diet as a sole weight loss intervention (8).

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Several observational studies have been conducted on the role of physical activity in preventing
weight regain after an initial sizable weight loss (9-13). Although these studies had different
study design and methodology, all of them focused on people who had lost 30–50 lb (13.6–22.7
kg) and had not regained after several years. Studies using self-reported physical activity and
energy expenditure generally support the notion that 60–90 mins of moderate-intensity physical
activity per day might be necessary for weight maintenance after such large weight losses (11-
12).

Recommendations for Exercise Prescription


Adults who are overweight or obese should be encouraged to increase their physical
activity levels even if they do not lose weight as a result, because physical activity can
bring other health benefits such as reduced risk of type 2 diabetes and cardiovascular
disease. Overweight or obese adults should be encouraged to perform at least 30 mins
of at least moderate-intensity physical activity on 5 or more days a week. The activity can
be undertaken in one session or several lasting 10 mins or more. For those who have
already achieved this level of activity, an increase in the amount of their physical activity is a
reasonable component of any strategy to lose weight. It is generally estimated that 1 pound
(0.45kg) of body fat loss requires about 3,500 kcal of energy consumption. As studies
on the effect of prescription of muscle strengthening exercise on weight loss are limited,
it seems reasonable to recommend overweight/obese people to follow the same muscle
strengthening exercise recommendations for the general population for having a balanced
exercise programme.

The following is the recommended FITT framework for prescribing aerobic exercises to
people who are overweight and obese:

Recommendations*

Frequency • ≥5 days per week of aerobic exercises to maximise caloric expenditure


(14).

Intensity • Moderate- to vigorous-intensity aerobic exercises should be


encouraged.
• Some individuals may prefer doing vigorous exercise as it is less time
consuming, but vigorous exercise is probably not appropriate for the
very obese (BMI > approximately 35 kg/m2) (8).
• Individuals choosing to incorporate vigorous intensity activity into their
programme should do this gradually and after an initial 4–12 week
period of moderate-intensity activity (8).

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Time • To prevent obesity, people may need 45 to 60 mins of moderate-
intensity aerobic activity each day unless they also reduce their energy
intake (1).
• Patients who are overweight or obese should be prescribed a volume
of 45 to 60 mins of moderate-intensity activity a day (corresponding
to approximately 225 to 300 mins/week of moderate-intensity physical
activity or lesser amounts of vigorous physical activity) (5,8).
• People who have been obese and have lost weight should be advised
they may need to do 60 to 90 mins of activity a day to avoid regaining
of weight (1,5,8).
• Sedentary individuals should build up to their physical activity targets
over several weeks, starting with 10 to 20 mins of physical activity every
other day during the first week or two, to minimise potential muscle
soreness and fatigue (8).

Type • Walking is an excellent form of physical activity for overweight and


obese people (for obese, sedentary individuals, brisk walking often
constitutes moderate-intensity physical activity.) (8).
• Weight-bearing physical activity may be difficult for some individuals
with BMI over approximately 35 kg/m2, particularly for those with
joint problems. For these individuals, gradually increasing non-weight-
bearing moderate-intensity physical activities (e.g. cycling, swimming,
water aerobics, etc.) should be encouraged (8).
* As many patients may present with comorbidities, it may be necessary to tailor the exercise prescription
accordingly.

Evaluation of Overweight or Obese Patients Before


Recommending an Exercise Programme
It is important to ensure that individuals have no contraindications to exercise before
commencing a physical activity programme. The presence of other comorbidities (e.g.
dyslipidaemia, hypertension, hyperinsulinaemia, hyperglycaemia, etc.) may increase the
risk stratification for overweight and obese individuals, resulting in the need for additional
medical screening before exercise testing. The presence of musculoskeletal and/or
orthopaedic conditions and limitations of exercise capacity may require modifications to the
exercise testing procedure.

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Special Considerations

Prescription of higher physical activity targets (i.e. >300 mins per week of moderate-
intensity physical activity) only resulted in significantly greater weight loss when
participants received additional support, such as inclusion of family members in
programme, small group meetings with exercise coaches or small monetary incentives, to
help them to achieve their activity goals (15). When additional support is not provided,
prescription of higher physical activity targets may not result in significantly greater
weight loss than prescription of standard physical activity (8).

References
1. National Institute for Health and Clinical Excellence (NICE). Obesity: the prevention, identification, assessment
and management of overweight and obesity in adults and children. London: NICE; 2006.
2. Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: a systematic review of the
literature. Obes Rev 2006;7(2):183-200.
3. Fogelholm M, Lahti-Koski M. Community health-promotion interventions with physical activity: does this
approach prevent obesity? Scand J Nutr 2002;46(4):173-77.
4. Asikainen TM, Kukkonen-Harjula K, Miilunpalo S. Exercise for health for early postmenopausal women: A
systematic review of randomised controlled trials. Sports Med 2004;34(11):753-78.
5. Saris WH, Blair SN, van Baak MA, Eaton SB, Davies PS, Di Pietro L, et al. How much physical activity is enough
to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement.
Obes Rev 2003;4(2):101-14.
6. Slentz, C. V., B. D. Duscha, J. L. Johnson, et al. Effects of the amount of exercise on body weight, body
composition, and measures of central obesity: STRRIDE-A randomized controlled study. Arch. Intern. Med
2004;164:31–9.
7. Stephanick, M. L. Exercise and weight control. Exerc. Sport Sci. Rev 1993; 21:363–96.
8. Management of obesity. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines
Network (SIGN); 2010 Feb.
9. Klem, M. L., R. R. Wing, W. Lang, M. T. Mcguire, and J. O. Hill. Does weight loss maintenance become easier
over time? Obes. Res 2000; 8:438–44.
10. Mcguire, M. T., R. R. Wing, M. L. Klem, H. M. Seagle, and J. O. Hill. Long-term maintenance of weight loss:
do people who lose weight through various weight loss methods use different behaviors to maintain their
weight? Int J Obes Relat Metab Disord 1998; 22:572–7.
11. Schoeller, D. A., K. Shay, and R. F. Kusher. How much physical activity is needed to minimize weight gain in
previously obese women? Am J Clin Nutr 1997; 66:551–6.
12. Weinsier, R. L., G. R. Hunter, R. A. Desmond, N. M. Byrne, P. A. Zuckerman, and B. E. Darnell. Free-living
activity energy expenditure in women successful and unsuccessful at maintaining a normal body weight. Am
J Clin Nutr 2002; 75:499–504.
13. Wing, R. R., and J. O. Hill. Successful weight loss maintenance. Annu Rev Nutr 2001; 21:323–41.
14. Exercise Prescription for Other Clinical Populations. In Walter R Thompson; Neil F Gordon; Linda S Pescatello;
ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine, 2010, P.
254
15. Jeffery RW, Wing RR, Sherwood NE, Tate DF. Physical activity and weight loss: does prescribing higher physical
activity goals improve outcome? Am J Clin Nutr 2003;78(4):684-9.

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