Physical Activity and Weight Loss

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This content is taken from the IAPAM’s Medically Supervised Weight Loss training program.  The program is designed to help physicians incorporate a medical weight loss program into their medical practice.

An increase in physical activity is an important component of weight loss therapy, although it will not lead to substantially greater weight loss over 6 months. Most weight loss occurs because of decreased caloric intake. Sustained physical activity is most helpful in the prevention of weight regain. In addition, it has a benefit in reducing cardiovascular and diabetes risks beyond that produced by weight reduction alone. For most obese patients, exercise should be initiated slowly, and the intensity should be increased gradually. The exercise can be done all at one time or intermittently over the day. Initial activities may be walking or swimming at a slow pace. The patient can start by walking 30 minutes for 3 days a week and can build to 45 minutes of more intense walking at least 5 days a week. With this regimen, an additional expenditure of 100 to 200 calories per day can be achieved. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week.

This regimen can be adapted to other forms of physical activity, but walking is particularly attractive because of its safety and accessibility. Patients should be encouraged to increase “every day” activities such as taking the stairs instead of the elevator. With time, depending on progress and functional capacity, the patient may engage in more strenuous activities. Competitive sports, such as tennis and volleyball, can provide an enjoyable form of exercise for many, but care must be taken to avoid injury. Reducing sedentary time is another strategy to increase activity by undertaking frequent, less strenuous activities.

Source: NAASO/NHLBI

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Long Term Weight Loss and Exercise Studies

Long-term weight loss after diet and exercise: a systematic review.

Source: International Journal of Obesity (London) 2005 Oct; 29(10): 1168-74
Diet associated with exercise produced a 20% greater initial weight loss. (13 kg vs 9.9 kg; z=1.86-p=0.063, 95%CI). The combined intervention also resulted in a 20% greater sustained weight loss after 1 y (6.7 kg vs 4.5 kg; z=1.89-p=0.058, 95%CI) than diet alone. In both groups, almost half of the initial weight loss was regained after 1 year.

CONCLUSION: Diet associated with exercise results in significant and clinically meaningful initial weight loss. This is partially sustained after 1 year.

Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity

Source: Cris A. Slentz, PhD; et al. Archives of Internal Medicine. 2004;164:31-39.

In non-dieting, overweight subjects, the controls gained weight, both low-amount exercise groups lost weight and fat, and the high-amount group lost more of each in a dose-response manner. These findings strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day.

It should also be noted other studies say the amount of daily exercise should be closer to 1 hour a day. (Successful Weight Loss Maintenance. Wing, Rena R.; Hill, James O. Annual Review of Nutrition v. 21 (2001) p. 323-41)

Exercise and Abdominal Obesity

No one will dispute the fact if a patient exercises regularly, the benefits are both physical and mental. The patient will most certainly benefit from a cardiovascular workout and a resistance workout. It is also known that building muscles takes a larger amount of calories than doing only cardio work.

Many patients are concerned about getting rid of the spare tire, and are very distressed that they just can’t. One study found limited evidence suggesting that “exercise-induced weight loss” is associated with reductions in abdominal obesity as measured by waist circumference or imaging methods; however, at present there is insufficient evidence to determine a dose-response relationship between physical activity, and abdominal or visceral fat. (Physical activity, total and regional obesity: dose-response considerations. Medicine and Science in Sports and Exercise. Volume 33(6) Supplement, June 2001, pp. S521-S527)

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