Exercise in the management of obesityA personal approachJohn Searle

Chief Medical Officer, Fitness Industry Association

If you assume…

You make an ass out of you and me

The context

• It is complex• It is difficult• My own practice

Personal training practice

• Nice middle class clients

Where do you begin?

• Why have you come to see me?

I want to lose weight

Specific goal or event

Fear

Where do you begin?

Start to widen the focus solely from weigh loss towards health and fitness

Assessment

• Health and medical history

• Activities of daily living

• Keep away from food!

Assessment

• Heart rate• BP• BMI• Body composition• Waist circumference• ? photograph

Planning exercise

Gradually increase the activities of daily living

Eating

• Food diary at about 3 weeks

• Food pyramid• One change at a

time• Weight after ADLs

have increased• ? Target weight

Aerobic exercise

• Frequency• Intensity• Time • Type

Frequency

• Every day as part of ADLs

• Higher intensity - 3 x a week

Intensity

Moderate intensity:

• increase in heart rate • a little breathless,• can complete a sentence

Time

Moderate intensity - 150’ a week

Higher intensity - 75’ a week

(cannot complete a sentence when exercising)

Monitoring progress

• Duration of exercise

• Rate of perceived exertion

• Heart rate

Type - low impact!

walking on treadmill with gradient

Cross trainer

Rower

Cycling or stationary bike

Resistance exercises

• Increase volume of aerobic work

• Increases self-esteem

• Increases basal metabolic rate

• Improves balance and coordination

Resistance exercises :FITT

• 2 x a week• 2 sets of 15 repetitions• Eccentric more beneficial than

concentric• Functional - large muscle groups

Flexibility

Motor skills

Monitoring progress

Weight is important but widen the focus to health, fitness and wellbeing

• encourage• affirm • keep going• keep in touch

The downside

• Personal and individual - group classes

• Expensive - really?• Requires high skill levels - so do most

aspects of healthcare• People are not convinced - not least,

NHS staff!

A 4 pronged attack