Effect of exercise in treatment of obesity

T.Ahadi MDGr.Raissi MD

Assistant professor of physical medicine and rehabilitation

Prevalence of obesity

Prevalence of obesity

Why Exercise prescription is important in obesity?

Obesity is associated with numerous health problems and earlier mortality. Exercise is effective for these co morbidities.

Attempted weight loss is a common behavior, approximately 40% of women and 25% of men try to lose weight

Benefits of Exercise in obesity

Cardiovascular

-Improved cardiovascular performance

-Slowing at atherosclerosis

-Blood pressure reduction

-Increased peripheral blood flow

- Lower pulse rate

- Larger stroke volume

Benefits of Exercise in obesity

Metabolic

-Improve Lipid profile

-Decrease type2 DM

-Reduction of truncal obesity

-Increase of basic metabolic rate Reduction the rate of cancer (reproductive, Colon) Reduction the risk OA and OP

Benefits of Exercise in obesity

Psychological

-Improve self image

-Decrease anxiety

-Improve the symptoms of depression

Cochrane Review

Exercise for overweight or obesity (Cochrane Review)

Main resultsThe 43 studies included 3476 participants. 1-When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone . Increasing exercise intensity increased the magnitude of weight loss

Exercise for overweight or obesity (Cochrane Review)

2 -Exercise as a sole weight loss intervention resulted in significant

reductions in diastolic blood pressure, triglycerides and fasting glucose.

No significant LDL reduction was detected, but HDL increase significantly.

Higher intensity exercise resulted in greater reduction in

fasting serum glucose than lower intensity exercise Exercise for overweight or obesity (Review) 1 Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd

Pre exercise evaluation Current and previous exercise patterns. Preferred types of exercise activity. Review of heart disease risk factors: (family history of heart disease before age 50; diabetes,

hypertension, smoking, hyperlipidemia; and sedentary lifestyle and obesity).

Current medical problems (cardiac, pulmonary, and musculoskeletal) .

History of exercise-induced symptoms (chest pain,shortness of breath,).

Time and scheduling considerations. Social support for exercise. Current medications

Goal Writing

“Ink it, don’t think it.”

SMART Specific Measurable Achievable Realistic Timed

Goal writing

Defining the expected goalsspecifying the target weightQuantifying the performance Specifying the time period

”10%weight loss in 6month- 0/2-0/4 kg/wk.”

Goal Writing (continued)

Goals should be specified as:

Short-term - STG – within 6 month

Long-term – LTG – After 6 month

Exercise prescription (FITT formula)

FrequencyNumber of sessions each week

IntensityDegree of effort put forth by the individual during

exercise. Time

Duration of activity Type

Mode of exercise being performed

Planning an exercise Program Threshold of training

Minimal level of exercise needed to achieve desired benefits.

Target zone Defines the upper limits of training and the optimal level of

exercise.

FITT formula Frequency, Intensity, Time, and Type Manipulate these factors to produce an individualized

exercise program.

Needs and goals of individual Program should meet the goals of the individual

Goal Initial goal of weight-loss therapy is to reduce BW by

approximately 10% from baseline within 6 months of therapy.

For patients with BMIs in the 25 to 35 range, a decrease of 300 to 500 kcal/d results in weight losses of about 0.23 to

0.45 kg/wk and a 10% loss in 6 months (Table 1). For more severely obese patients with BMIs greater than 35 kg/m2, deficits of up to 500 to 1,000 kcal/d lead to

weight losses of about 0.45to 0.90 kg/wk and a 10% weight loss in 6 months

Goal The minimal amount of

accumulated physical activity generally recommended to achieve a degree of protection from chronic diseases (30 min/d) is insufficient for most persons to maintain BW in the desirable BMI range (18.5–24.9 kg/m2).

Exercise

Nutrition

Cognitive- behavior

therapy

FITT Formula

Frequency:

Start from 3d/wk

Goal is 5d/wk or near all d/wk

Prim Care Clin Office Pract 36 (2009) 379–393

FITT Formula Intensity: between 45% to 85% of the maximal

heart rate - maximal heart rate : By subtracting a patient’s age

from 220 (for men) or 226 (for women), a maximal heart rate can be calculated.

- Adjustments in intensity should be made based on a person’s baseline level of fitness, with lower-intensity exercise recommended for less fit individuals.

Prim Care Clin Office Pract 36 (2009) 379–393

FITT Formula

Time:

-Start from 30 min/d

Goal is 45 min/d and more

-For weight maintenance 60-80min/d

FITT Formula Type:Aerobicactivities (Jogging,Running,Walking,Dancing,Biking,Swimming) Aerobic EX is the choice because of cardio respiratory effects - large muscle groups are used in continuous rhythmic activity for prolonged

periods.- Aerobic activities provide isotonic exercise, whereby skeletal muscle fibers shorten in length with little change in tension. -During isotonic exercise, heart rate and cardiac output increase, but peripheral

vascular resistance falls. -During isometric exercise muscle tension increases with little change in fiber

length, producing a marked increase in peripheral vascular resistance and blood pressure with little increase in cardiac output

Patient should enjoy the activity an exercise prescription should contain recommendations for resistance

training and flexibility training at least twice a week

Flexibility

Maximum range of motion possible at a joint

Can prevent muscle injuries; improve low-back pain

Strengthening exercise

Maintenance of proper posture; protect joints.

Production of power to enhance performance

Prevention of osteoporosis

Exercise for geriatric 2 main problem in Ex prescription in elderly- Differences in aerobic and functional capacity - Reduced strength and endurance of muscles

associated with aging and chronic Dis.

Flexibility training Resistance training

Aerobic exercise.

Exercise for obes children An exercise prescription similar to that for adults

appears appropriate for childrenolder than 6 years. Children should enjoy the EX. 6omin/d,moderate intencity,near all day/weak,

Aerobic EX Limit resistant training

Summery

45 min/d or more of aerobic Ex in 5 or preferably all days of the week with intencity of 45% to 85% of MaxHR

Strength-developing and flexibility activities at least twice a week.

Thank you