MPT presentation

1. Exercise Prescription In
Obesity
Denisha Beladiya
F Y MPT

2. Content
• Introduction
• Control of body weight
• Health Problems Linked With Excessive Weight and Obesity
• General Treatment of Obesity
• Role of physical activity in weight control
• Exercise Testing
• Exercise Prescription

3. Introduction
Overweight
• It is defined as a body weight that exceeds the normal or standard weight for a particular person
based on height and frame size.
Obesity
• Refers to the condition of having an excessive amount of body fat.
• Men with more than 25% body fat and women with more than 35% should be considered obese.
• Men with relative fat values of 20% to 25% and women with values of 30% to 35% should be
considered borderline obese.

4. Classification
• Body mass index (BMI) is now the most widely used clinical standard to estimate obesity

5. Control of body weight
• The average-sized person takes in about 2,500 kcal per day, or nearly 1 million kcal per year
• Body has ability to balance energy intake and expenditure to with in 8 to 15 kcal pr day
• Subjects placed on semistarvation diets have lost up to 25% of their body weight but regained that
weight within months of returning to a normal diet

6. • How is the body able to do this?
• Considering energy expenditure, the total amount of energy expended each day can be expressed as
the sum of its three components
1. Resting metabolic rate (RMR)
2. The thermic effect of a meal (TEM)
3. The thermic effect of activity (TEA)

7. Three component of energy expenditure

8. Resting metabolic rate(RMR)
• Body’s metabolic rate early in the morning following an overnight fast and 8 h of sleep.
• The term basal metabolic rate (BMR) also is used but generally implies that the person fasted for
12 to 18 h and slept over in the clinical facility where the BMR measurement would be made
• This value represents the minimal amount of energy expenditure needed to support basic
physiological processes.
• It accounts for about 60% to 75% of the total energy we expend each day.

9. Thermic effect of a meal (TEM)
• The thermic effect of a meal (TEM) represents the increase in the metabolic rate that is associated
with the digestion, absorption, transport, metabolism, and storage of ingested food.
• approximately 10% of our total energy expenditure each day.
• This value also includes some energy waste, because the body can increase its metabolic rate above
that necessary for food processing and storage.

10. Thermic effect of activity (TEA)
• It is simply the energy expended above the RMR to accomplish a given task or activity, whether it
is combing one’s hair or running a 10 km race.
• accounts for the remaining 15% to 30% of our energy expenditure.

11. Health Problems Linked With Excessive
Weight and Obesity
• Coronary heart disease
• Hypertension
• Stroke
• Type 2 diabetes
• Liver and gallbladder disease
• Osteoarthritis
• Sleep apnea and respiratory problems

12. Changes in Normal Body Function
• Respiratory problems are common among people with obesity, including sleep apnea.
• These can lead to other common consequences of obesity.
• These conditions can lead to abnormal blood clotting (thrombosis), enlargement of the heart, and
congestive heart failure.

13. General Treatment of Obesity
• To maintain weight, the energy consumed by the body in the form of food must equal the total
energy expended, which is the sum of the RMR, TEM, and TEA
• weight gains appear to depend largely on just two factors: dietary intake and physical activity
• Weight loss generally should not exceed 0.45 to 0.9 kg (1-2 lb) per week.
• Losses greater than this should not be attempted without direct medical supervision.
• Losing just 0.45 kg (1 lb) of fat a week will result in the loss of 23.4 kg (52 lb) of fat in only a
year!

14. • A person should learn to make permanent changes in dietary habits, especially reducing the intake
of fat and simple sugars.
• For most people, simply eating a low-fat diet will gradually reduce weight to a desirable level
• reducing total caloric intake by 250 to 500 kcal per day, combined with a selection of low-fat and
low simple sugar foods, would be sufficient to accomplish their desired weight loss goals.
• Hormones and drugs also have been used to assist patient in weight loss by decreasing their
appetite or increasing RMR

15. Role of physical activity in weight control
Changes in Body Composition With Exercise Training
 Mechanisms for Change in Body Weight and Composition
o Exercise and Appetite
o Exercise and Resting Metabolic Rate
o Exercise and the Thermic Effect of a Meal
o Exercise and Mobilization of Body Fat
Low-Intensity Aerobics

16. Changes in Body Composition With Exercise
Training
• Physical training can alter body composition.
• A person who jogs three days a week for 30 min each day at an 11 km/h (7 mph) pace (slightly
over 5.4 min/ km, or 8.5 min/mi) will expend about 14.5 kcal/min, or 435 kcal, for the 30 min run
each day.
• This results in a total expenditure per week of about 1,305 kcal, the equivalent loss of about 0.15
kg of adipose tissue (fat plus connective tissue and water) each week just from the exercise period
alone.

17. • However, in 52 weeks, providing energy intake remained constant, this person would lose 7.8 kg
(17 lb)
• Metabolism remains temporarily elevated after exercise ends.
• This phenomenon was at one time referred to as the oxygen debt but, now referred to as the excess
postexercise oxygen consumption (EPOC)

18. • Studies have shown relatively small, but significant changes in both weight and body composition
with both aerobic and resistance training, which include
 total weight decrease,
 fat mass and relative body fat decrease, and
 either maintained or increased fat-free mass.

19. Mechanisms for Change in Body Weight and Composition
• The energy-balance equation
energy intake– energy excreted= RMR + TEM + TEA.

20.  Exercise and Appetite
• certain minimal level of physical activity is necessary for the body to precisely regulate food intake
to balance energy expenditure.
• decrease in appetite might occur only with intense levels of exercise, in which the resulting
increased catecholamine (epinephrine and norepinephrine) levels might suppress the appetite
• The increased body temperature that accompanies either high-intensity activity or almost any
activity performed under hot and humid conditions also might suppress appetite.

21. Exercise and Resting Metabolic Rate
• Because RMR is closely related to the fat-free mass of the body (fat-free tissue is more
metabolically active), interest has increased in the use of resistance training to increase fat-free
mass in an attempt to increase RMR.
• highly trained runners have higher RMRs than untrained people of similar age and size.

22. • Exercise and thermic effect of meal
• A single bout of exercise, either before or after a meal, increases the thermic effect of that meal

23. • Exercise and Mobilization of Body Fat
• During exercise, fatty acids are freed from their storage sites to be used for energy.
• human growth hormone may be responsible for this increased fatty acid mobilization
• Exercise increases lipid mobilization from adipose tissue.

24. • Low-Intensity Aerobics
• the higher the exercise intensity, the greater the body’s reliance on carbohydrate as an energy
source.
• low-intensity aerobic training would allow the body to use more fat as the energy source, hastening
the loss of body fat
• Indeed, the body uses a higher percentage of fat for energy at lower exercise intensities.

25. Exercise Testing
• An exercise test is often not necessary in the overweight/obese population prior to beginning a
low-to-moderate intensity exercise program.
• Overweight and obese individuals are at risk for other comorbidities (e.g., dyslipidemia,
hypertension, hyperinsulinemia,), which are associated with CVD risk.
• The timing of medications to treat comorbidities relative to exercise testing should be considered,
particularly in those take β-blockers and antidiabetic medications.
• The presence of musculoskeletal and/or orthopedic conditions may necessitate the need for using
leg or arm ergometry.

26. • The potential for low exercise capacity in individuals with overweight and obesity may necessitate
a low initial workload (i.e., 2–3 METs) and small increments per testing stage of 0.5–1.0 MET.
• The appropriate cuff size should be used to measure BP in individuals who are overweight and
obese to minimize the potential for inaccurate measurement.

27. Exercise Prescription

28. Exercise Training Considerations
• The duration of moderate-to-vigorous intensity physical activity should initially progress to at least
30 min · d−1.
• To promote long-term weight loss maintenance, individuals should progress to at least 250 min ·
wk−1 of moderate-to-vigorous exercise.
• To achieve the weekly maintenance activity goal of ≥250 min · wk−1, physical activity should be
performed on 5–7 d · wk−1.
• physical activity in multiple daily bouts of at least 10 min in duration or through increases in other
forms of moderate intensity lifestyle PA should be done.

29. • intermittent exercise may increase the volume of PA achieved by previously sedentary individuals
and may enhance the adoption and maintenance of PA
• Resistance training does not result in clinically significant weight loss
• Resistance exercise may enhance muscular strength and physical function in individuals who are
overweight or obese. Moreover, there may be additional health benefits of participating in
resistance exercise such as improvements in CVD and DM risk factors and other chronic disease
risk factors

30. Special Considerations
• Utilize goal setting to target short- and long-term weight loss. Target a minimal reduction in body
weight of at least 3%–10% of initial body weight over 3–6 month.
• Target reducing current energy intake to achieve weight loss. A reduction of 500–1,000 kcal · d–1
is adequate to elicit a weight loss of (0.5–0.9 kg · wk−1).
• This reduced energy intake should be combined with a reduction in dietary fat intake.
• Weight loss beyond 5%–10% may require more aggressive nutrition, exercise, and behavioral
intervention For those who do not respond to any degree of lifestyle intervention, medical
treatments such as medications or surgery may be appropriate.

31. • Incorporate opportunities to enhance communication between health care professionals, registered
dietitian nutritionists, and exercise professionals and individuals with overweight and obesity
following the initial weight loss period.
• Target changing eating and exercise behaviors because sustained changes in both behaviors result
in significant long-term weight loss and maintenance.

32. Reference