Increased Physical Activity

An increase in physical activity promotes weight loss through increased expenditure of energy and possibly through inhibition of food intake. Physical activity also helps to maintain a desirable weight and to reduce CHD risk beyond that produced by weight reduction alone. Several experts contend that a decrease in the amount of energy expended for work, transportation, and personal chores is a major cause of obesity in the United States. They note that total caloric intake has not increased over the last few decades; instead, the caloric imbalance leading to overweight and obesity is the result of a substantial decrease in physical activity and, consequently, a decrease in daily energy expenditure. This hypothesis is intriguing but not proven. Regardless, increased regular physical activity is the way to achieve this goal of augmenting daily energy expenditure.

Increased physical activity improves cardiorespira-tory fitness, with or without weight loss. The latter improves the quality of life in overweight patients by improving mood, self-esteem, and physical function in daily activities. Physical activity reduces elevated levels of CVD risk factors, including blood pressure and triglycerides, increases HDL cholesterol, and improves glucose tolerance with or without weight loss. Furthermore, the more active an individual is, the lower the risk for CVD morbidity and mortality, and diabetes. Physical activity apparently has a favorable effect on distribution of body fat. Several studies showed an inverse association between energy expenditure through physical activity and several indicators of body fat distribution. Only a few randomized controlled trials that have tested the effect of physical activity on weight loss measured waist circumference. In some (but not all) studies, physical activity was found to produce only modest weight loss and decreased waist circumference.

Many people live sedentary lives, have little training or skills in physical activity, and are difficult to motivate toward increasing their activity. For these reasons, starting a physical activity regimen may require supervision for many people. The need to avoid injury during physical activity is high. Extremely obese persons may need to start with simple exercises that can gradually be intensified. A decision must be made whether exercise testing for cardiopulmonary disease is needed before starting physical activity regimen. This decision should be based on a patient's age, symptoms, and concomitant risk factors.

For most obese persons, physical activity should be initiated slowly. Initial activities may be walking or swimming at a slow pace. Gradually, the patient may engage in more strenuous activities, such as fitness walking, cycling, rowing, cross-country skiing, aerobic dancing, and rope jumping. Jogging provides a high-intensity aerobic exercise. If jogging is recommended, the patient's ability to do this must first be assessed because it can cause orthopedic injuries. Competitive sports, such as tennis and volleyball, can motivate people to exercise, but care must be taken to avoid injury, especially in older people. Because amounts of activity are functions of duration, intensity, and frequency, the same amounts of activity can be obtained in longer sessions of moderately intense activities (such as brisk walking) as in shorter sessions of more strenuous activities (such as running). Daily walking is one good form of exercise, particularly those who are overweight or obese. Its helpful to start by walking 10 min 3 days a week, and can build to 30-45 min of more intense walking at least 5 days a week. With this exercise, an additional 100-200 calories per day of physical activity can be used. Although other forms of physical activity are acceptable, walking is particularly attractive because of its safety and accessibility.

Reducing sedentary time is another approach to increasing activity. Patients also should be encouraged to build physical activities into their lives. They should consider leaving public transportation one stop before the usual one, parking farther than usual from work or shopping, walking up stairs instead of taking elevators or escalators, gardening, and walking a dog every day. Of course, attention should be given to exercising in safe areas, e.g., community parks, gyms, pools, health clubs, an area of the home perhaps outfitted with a stationary bicycle or a treadmill. Helpful hints are planning exercise in advance, budgeting necessary time, and documenting duration and intensity of exercise.

Dieting Dilemma and Skinny Solutions

Dieting Dilemma and Skinny Solutions

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