Obesity is a significant public health concern, affecting approximately 42% of adults in the United States [2]. It is linked to an increased risk of serious health conditions, including type 2 diabetes, high blood pressure, cardiovascular disease, sleep disorders, osteoarthritis, and even premature death [2]. Individuals with obesity also face higher rates of cardiovascular events; for instance, men with a BMI between 30 and 39 have a cardiovascular event rate of 20.21 per 1000 person-years, compared to 13.72 per 1000 person-years for men with a normal BMI [2]. For women with a BMI between 30 and 39.9, the rate is 9.97 per 1000 person-years, versus 6.37 per 1000 person-years for those with a normal BMI [2]. While body mass index (BMI) is commonly used to define overweight (BMI of 25 or greater) and obesity (BMI of 30 or greater), it is important to note that BMI alone is not recommended for determining individual risk [2]. Physical activity, alongside a healthy diet, is a primary strategy in managing obesity and its related health issues [6].
Aerobic Exercise: Core Recommendations and Benefits
Aerobic physical activity is a foundational component of a healthy lifestyle for adults. Current recommendations suggest engaging in 30 to 60 minutes of moderate to vigorous intensity aerobic exercise on most days of the week [1]. This type of activity offers a range of benefits, particularly for individuals managing their weight or living with obesity:
- Achieving small amounts of body weight and fat loss [1].
- Reducing abdominal visceral fat (fat around organs) and ectopic fat (fat in places like the liver and heart), even if significant weight loss does not occur [1].
- Supporting weight maintenance after successful weight loss [1].
- Helping to preserve fat-free mass (muscle) during weight loss [1].
- Improving cardiorespiratory fitness and overall mobility [1].
For those looking to maximize improvements in cardiorespiratory fitness, increasing exercise intensity, including high-intensity interval training (HIIT), can be more effective than moderate-intensity aerobic exercise alone [1].
Strength Training: Building Muscle and Maintaining Weight
Beyond aerobic exercise, resistance training plays a crucial role in adult physical activity. This type of exercise can help promote weight maintenance and lead to modest increases in muscle mass or fat-free mass, while also improving mobility [1]. Functional training, which integrates both neuromuscular and cardiorespiratory stimuli, is another effective modality. It offers both physical and psychosocial benefits and can include high-intensity functional training (HIIT-F), multicomponent programs, or CrossFit-like interventions [7].
Beyond Weight Loss: Broader Health Improvements
The benefits of physical activity extend beyond just changes in body composition. Even a modest weight loss of 5% to 10% can significantly improve health markers, such as reducing systolic blood pressure by approximately 3 mm Hg in individuals with hypertension [2]. A case study involving a 65-year-old male patient with obesity demonstrated remarkable improvements over a 30-week lifestyle change program that included individualized exercise [5]. The patient experienced a significant decrease in body weight (24.1 kg, or 18.4%) and BMI, along with a reduction in resting heart rate and diastolic blood pressure [5]. Crucially, these improvements also led to a reduction in the need for antihypertensive and antidiabetic medications, highlighting the profound impact of regular, structured exercise on overall health and chronic disease management [5].
Getting Started and Staying Active
Despite the clear benefits, integrating regular physical activity into daily life can be challenging. Primary care physicians and nurses are in a unique position to motivate and advise patients on increasing physical activity [3]. However, studies indicate that general recommendations for physical activity are not always consistently implemented in routine clinical practice [3]. Patients are more likely to engage in behavior modification when encouraged by their physician [6]. For optimal results, an individualized exercise prescription is often necessary, requiring monitoring and guidance from an exercise professional [5]. Referring patients from clinical settings to other health professionals, such as exercise physiologists, can be a more effective method to ensure they receive the specialized support and resources needed to adopt and maintain an active lifestyle [6].
Sources
[1] Physical activity in obesity management. https://pubmed.ncbi.nlm.nih.gov/41378655/
[2] Obesity Management in Adults: A Review. https://pubmed.ncbi.nlm.nih.gov/38015216/
[3] Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study. https://pubmed.ncbi.nlm.nih.gov/32717839/
[4] Physical activity for the management of obesity in children up to the age of 9 years. https://pubmed.ncbi.nlm.nih.gov/42440326/
[5] The Role of Individualized Exercise Prescription in Obesity Management-Case Study. https://pubmed.ncbi.nlm.nih.gov/34831781/
[6] Physical activity, diet, and weight loss in patients recruited from primary care settings: An update on obesity management interventions. https://pubmed.ncbi.nlm.nih.gov/34631139/
[7] Effects of Functional Training on Body Composition in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. https://pubmed.ncbi.nlm.nih.gov/42496414/
[8] What guidance is available for people with epilepsy wanting to participate in sport and exercise? A narrative review. https://pubmed.ncbi.nlm.nih.gov/42164757/