Obesity in adults: Role of physical activity and exercise
- George A Bray, MD
George A Bray, MD
- Boyd Professor Emeritus, Pennington Biomedical Research Center/Louisiana State University
- Professor of Medicine Emeritus, Louisiana State University Health Science Center
- Leigh Perreault, MD
Leigh Perreault, MD
- Associate Professor of Medicine
- University of Colorado Anschutz Medical Campus
- Associate Professor of Epidemiology
- Colorado School of Public Health
A large body of observational data show an association between higher levels of physical activity and lower rates of many chronic diseases [1-5]. Conversely, physical inactivity is a component of reduced life expectancy [5,6]. The energy produced by physical activity is a component of energy balance that is particularly important in the pathogenesis of obesity and in its treatment. The components of energy expenditure are resting (basal) energy expenditure (REE) (eg, heat production for maintenance of body temperature, maintenance of ionic gradients across cells, and resting cardiac and respiratory function), diet-induced thermogenesis, and physical activity (figure 1) .
The optimal management of overweight and obesity starts with a combination of diet, exercise, and behavioral modification . In addition, some patients eventually require pharmacologic therapy or bariatric surgery. Physical exercise and activity are also important for maintaining long-term weight loss and can be beneficial in preserving lean body mass while dieting. A dose-response relationship has been demonstrated in overweight adult women between the amount of exercise and long-term weight loss maintenance .
This role of physical activity in the prevention and treatment of obesity will be reviewed here. Basal metabolic activities, thermogenesis, and other interventions in the management of obesity are reviewed separately. (See "Pathogenesis of obesity" and "Obesity in adults: Overview of management" and "Obesity in adults: Behavioral therapy" and "Obesity in adults: Dietary therapy".)
Obesity in children and adolescents is reviewed separately. (See "Definition; epidemiology; and etiology of obesity in children and adolescents" and "Management of childhood obesity in the primary care setting".)
MEASUREMENT OF PHYSICAL ACTIVITY
The gold standard for measurement of total daily energy expenditure (TEE) is the doubly labeled water technique . Energy expenditure from activity can be estimated by subtracting resting energy expenditure (REE) and the thermic effect of food , also called diet-induced thermogenesis, from TEE measured by doubly labeled water technique. The physical activity level (PAL) can also be expressed as the ratio of TEE (from doubly labeled water) to REE and is usually in the range of 1.5 to 1.8.
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- MEASUREMENT OF PHYSICAL ACTIVITY
- PREVENTION OF WEIGHT GAIN
- TREATMENT FOR OBESITY
- Exercise as a single treatment
- Exercise plus diet
- Addition of "activity trackers"
- Maintenance of weight loss
- OVERALL HEALTH
- A PROGRAM FOR PHYSICAL ACTIVITY
- Pre-exercise evaluation
- Exercise duration
- Exercise type and intensity
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS