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 metabolic rate (RMR), the thermic effect of feeding (TEF), and physical activity (figure 1) .
The initial management of overweight and obesity includes a combination of diet, exercise, and behavioral modification . Some patients may eventually require pharmacologic therapy or bariatric surgery to augment weight loss and weight loss maintenance. Physical exercise and activity are also important for maintaining long-term weight loss and are key 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 .
The 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 "Genetic contribution and pathophysiology 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".)
Physical activity improves physical and mental health in a wide range of domains . Conversely, a sedentary lifestyle in adults has been associated with increased mortality . In a prospective study of 17,013 Canadian adults, there was a progressively higher risk of all-cause and cardiovascular mortality across higher levels of sitting time [11,12]. It should be noted that the Surgeon General's recommendation for physical activity (ie, 30 minutes three times per week) is for the promotion of cardiovascular health and not for the prevention or treatment of obesity.
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- OVERALL HEALTH
- Measurement of physical activity
- PREVENTION OF OVERWEIGHT/OBESITY
- TREATMENT FOR OBESITY
- Exercise as a single treatment
- Exercise plus diet
- Aerobic or resistance exercise
- Addition of "activity trackers"
- Maintenance of weight loss
- A PROGRAM FOR PHYSICAL ACTIVITY
- Pre-exercise evaluation
- Exercise duration
- Exercise type and intensity
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS