1. 1. Dr. KANNABIRAN BHOJAN .PhD, P.T PROFESSOR, RVS COLLEGE OF PHYSIOTHERAPY ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST
2. 2. physical workout
3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
30. 30. Thank you