Role of physical workout, The “Magic Pill” i n obese peo ple Dr. KANNABIRAN BHOJAN .PhD, P.T PROFESSOR, RVS COLLEGE OF PHYSIOTHERAPY ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST
1. Dr. KANNABIRAN BHOJAN .PhD, P.T PROFESSOR, RVS COLLEGE OF
PHYSIOTHERAPY ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST
2. physical workout
3. Topic Outline The importance & facts about Physical
Activity in Obesity Management on: Weight loss Weight loss
maintenance Physical activity & obesity prevention Effects on
general health risks Mechanisms of Action Present Recommendations
for Physical Activity in Obesity Translating Physical Activity
Recommendations into Increased Physical Activity in Patients
4. Weight Loss Mode Frequency Weight Loss Epstein and Wing
Walk/run 2 - 5x/wk 0.09 kg/wk Ballor and Kessey Walk/run/cycle 3 -
4x/wk 0.1 kg/wk Garrow and Summerbell Walk/run/cycle 3 - 4x/wk 0.1
kg/wk Hadjiolva, et al Various Daily (10 hrs/day) 1.8 kg/wk Lee, et
al Military Training 5x/wk 0.6 kg/wk Zachwieja JJ. Endocrinol Metab
Clin North Am 1995;25:965-988. Effect of Physical Activity Without
Diet on Body Weight Loss
5. Physical Activity Usually Does Not Increase Short-Term
Diet-Induced Weight Loss Wing. Med Sci Sports Exerc.
1999;31(suppl):S547. Each study ranged from 4 to 6 months *P <
0.05 vs diet-only group Blonk 1994 Sweeney 1993 -15 -10 -5 0 Weight
Loss (kg) * Diet only Diet + exercise Wadden 1997 Ross 1996 Marks
1995 Ross 1995 Bertram 1990
6. Physical Activity and Weight Loss Most studies suggest a
reasonable amount of physical activity does not produce weight loss
Exercise alone - 0.06 to 0.1 kg/week Dose response relationship
does not significantly increase initial weight loss over what is
obtained by caloric restriction alone
7. Weight Loss Maintenance: 0 2 4 6 8 10 12 14 BCDD BCDD &
Exercise VLCD VLCD & Exercise 8 weeks 18 months Adapted from
Pavlou KN, et al. Am J Clin Nutr. 1989;49:1115-1123.
8. Weight Loss Maintenance: calories burnt /week? Jeffery RW et
al AJCN 2003;78:684-9. -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 0 6 12 18
WeightChange(kg) Time (mo) 1000 kcal/wk 2500 kcal/wk * ** n = 84 n
= 102 n = 87 n = 76 n = 80 n = 87
9. Physical Activity and Weight Loss Maintenance Data from case
studies, correlation studies and randomized control trails have all
concluded that high levels of physical activity facilitate
maintenance of weight loss long-term
10. Prevention: 73 74 75 76 77 78 79 80 81 82 83 Base 4 Months
9 Months 12 Months 16 Months Weight(kg) Control Exercise Donnelly
J, Jacobsen D, Hill JO. Archives of Internal Medicine
163:1343-1350, 2003.
11. Physical Activity and General Health Moderate levels of
cardiorespiratory fitness substantially reduce mortality risks
associated with overweight and obesity Moderate levels of
cardiorespiratory fitness can be developed in 30 minutes of
activity at least 5 days per week
12. Study results on post training Katzmaryck PT, Leon AS,
Wilmore JH, et al. Med Sci Sports Exerc, 2003; Vol. 35, No. 10,
17031709. Prevalence of individual risk factors before and after 20
wk of aerobic exercise training in the HERITAGE Family Study among
105 participants with the metabolic syndrome at baseline. *P <
0.05 pre- versus post-training. 100 90 80 70 60 50 40 30 20 10 0
High TG Low HDL-C High BP High Glucose High WC Metabolic Syndrome
Pre-Training Post-Training * * * *
13. Differences Between Weight Loss and Weight Loss Maintenance
Weight Loss Maintenance of Weight Loss Time limited Requires a
negative energy balance Reduced caloric intake is critical Physical
activity not required for success Common Life-long Requires energy
balance at a reduced body weight Physical activity is critical for
success Rare Why the difference in impact for physical activity
between weight loss and weight loss maintenance?
14. Mechanism of Action Makes it more likely for patients to
remain in Energy Balance at a reduced body weight Possibilities
include: Direct compensation for diet carelessness Prevent or
decrease metabolic efficiency associated with weight loss Improved
self-efficacy or mood Improved satiety/hunger Allows better
physiological matching of intake and expenditure to occur Why Is
Physical Activity Critical for Long-Term Success?
15. Physiological Control Maximized Energy Intake Energy
Expenditure Obesity Conducive Environment Cognitive Control
Required Activity Intake A B C Potential Effects of Increasing
Physical Activity vs. Decreasing Intake on Encouraging
Physiological Energy Balance
16. Physical Activity Recommendations: 30 minutes of physical
activity every day is all I need to do to manage my weight A Common
Patient Misconception
17. Current Recommendations Minimal public health
recommendations to improve health related outcomes 30 min moderate
activity most days of the week (150 minutes/week) CDC - Centers for
Disease Control ACSM - American College of Sports Medicine SG -
Surgeon General Maximize weight loss and prevent weight regain
45-60 minutes/day IOM - Institutes of Medicine 60-90 minutes/day
IASO - International Assoc for Study of Obesity 60 minutes/day (300
minutes/week) ACSM - American College Sports Medicine Preventing
general weight gain Unclear
18. Weight Loss Maintenance: definitely possible, how? 58 60 62
64 66 68 70 72 74 76 78 0 3 6 9 12 Weight(kg) Time (months)
Sedentary Moderately active Active Schoeller et al, AJCN
1997;66:551-6.
19. Weight Loss Maintenance: How Much ? Women in the physically
active group gained the least weight after reaching their target
for weight loss Retrospective analysis: Threshold of 11 kcal/kg of
body wt/day 80 minutes of moderate intensity activity or 35 minutes
of vigorous activity Supports that body weight is better regulated
at a higher energy flux Schoeller et al, AJCN 1997;66:551-6.
20. Average Energy Expended in Physical Activity in the NWCR
2545 3293 0 500 1000 1500 2000 2500 3000 3500 4000 KCal Women Men
Klem et al, AJCN 1997;66:239-46.
21. Intensity? Studies suggest the intensity of physical
activity may have limited impact on weight control when total
energy expenditure (TEE) is fixed High levels of energy expenditure
(EE) improve weight management So if vigorous intensity results in
greater EE weight loss outcomes will improve So if moderate
intensity results in greater EE weight outcomes will improve
Moderate intensity provides health benefits while presenting low to
moderate health risks
22. Planned vs Lifestyle Activity Planned Activity- completed
in a discrete period of time, moderate to high intensity 30 to 60
minutes Walking, swimming, biking Lifestyle Activity- completed
during everyday tasks Parking further away, taking stairs, walk to
meetings
23. Mean Changes in Body Weight for Lifestyle Activity vs
Aerobic Exercise -10 -8 -6 -4 -2 0 ChangeinWeight(kg) Week Diet +
Aerobic Diet +Lifestyle Anderson et al. JAMA 1999; 281: 337.
24. Long vs Short Bouts Multiple short bouts are as effective
as one long bout and perhaps may facilitate efforts to increase
activity Helps address the barrier of perceived lack of time
Multiple short bouts increase adoption of physical activity during
first 6 months Long-term impact is less clear Jakicic JM et al.
JAMA 1999;282(16):1554-60. Jacobsen DJ et al. Int J Sports Med
2003;24:459-64.
25. Physical Activity - The Magic Pill What Patients need
Currently available Safe, cheap and effective Increase my
metabolism Burn fat as fuel Allow me to eat more food without
gaining weight Make me healthier
26. How to Get Your Overweight Patients to Be More Active For
many individuals, starting a structured exercise program is not
possible Therefore: Implement small lifestyle changes to increase
daily physical activity Park at a long distance of lot when driving
to shopping/store Keep the phone/ mobile far away in house so
patient has to walk to use it Find the stairs! Walk to friends
office at work instead of calling on the phone Use lift only if
going up more than 2 floors Decrease sedentary activity
27. Lifestyle Activity Program Wear a pedometer every day for a
week to determine baseline Increase steps by 500 steps/day /week
Ultimate goal 10,000 - 15,000 steps/day 500 steps = 5 minutes
walking moderate Helps set goals and gives instantaneous feedback
Do all those little changes that contribute EE?
28. Then ? After these lifestyle alterations are in place,
start on a structured exercise plan Start slow - perhaps as little
as 5 - 10 min of activity per day (whatever they enjoy and will
continue to do) Total amount of activity is what counts
29. Conclusions Physical activity recommendations of 30 minutes
most days of the week are based on improving cardiovascular health
- a good initial or minimal goal 60 - 80 minutes of physical
activity may be what is necessary to prevent regain following a
weight loss (long-term goal) Risk factors associated with Metabolic
Syndrome improve with physical activity How to get patients to do
what we know it takes is the real problem Lifestyle changes and
short bouts of activity in sedentary individuals may be the place
to start Gradual increase over 1 - 2 years may be necessary
Long-term adherence is the most important goal