1. Effect of exercise in treatment of obesity T.Ahadi MD Gr.Raissi MD Assistant professor of physical medicine and rehabilitation

2. Prevalence of obesity

4. Why Exercise prescription is important in obesity? u Obesity is associated with numerous health problems and earlier mortality. Exercise is effective for these co morbidities. u Attempted weight loss is a common behavior, approximately 40% of women and 25% of men try to lose weight

5. Benefits of Exercise in obesity u Cardiovascular -Improved cardiovascular performance -Slowing at atherosclerosis -Blood pressure reduction -Increased peripheral blood flow -Lower pulse rate -Larger stroke volume

6. Benefits of Exercise in obesity u Metabolic -Improve Lipid profile -Decrease type2 DM -Reduction of truncal obesity -Increase of basic metabolic rate u Reduction the rate of cancer (reproductive, Colon) u Reduction the risk OA and OP

7. Benefits of Exercise in obesity u Psychological -Improve self image -Decrease anxiety -Improve the symptoms of depression

8. Cochrane Review

9. Exercise for overweight or obesity (Cochrane Review) u Main results The 43 studies included 3476 participants. 1-When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone. Increasing exercise intensity increased the magnitude of weight loss

10. Exercise for overweight or obesity (Cochrane Review) 2 -Exercise as a sole weight loss intervention resulted in significant reductions in diastolic blood pressure, triglycerides and fasting glucose. No significant LDL reduction was detected, but HDL increase significantly. Higher intensity exercise resulted in greater reduction in fasting serum glucose than lower intensity exercise Exercise for overweight or obesity (Review) 1 Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd

11. Pre exercise evaluation u Current and previous exercise patterns. u Preferred types of exercise activity. u Review of heart disease risk factors: (family history of heart disease before age 50; diabetes, hypertension, smoking, hyperlipidemia; and sedentary lifestyle and obesity). u Current medical problems (cardiac, pulmonary, and musculoskeletal). u History of exercise-induced symptoms (chest pain,shortness of breath,). u Time and scheduling considerations. u Social support for exercise. u Current medications

12. Goal Writing “Ink it, don’t think it.”

13. SMART u Specific u Measurable u Achievable u Realistic u Timed

14. Goal writing u Defining the expected goals ä specifying the target weight ä Quantifying the performance ä Specifying the time period ”10%weight loss in 6month- 0/2-0/4 kg/wk.”

15. Goal Writing (continued) u Goals should be specified as: ä Short-term - STG – within 6 month ä Long-term – LTG – After 6 month

16. Exercise prescription (FITT formula) u Frequency ä Number of sessions each week u Intensity ä Degree of effort put forth by the individual during exercise. u Time ä Duration of activity u Type ä Mode of exercise being performed

17. Planning an exercise Program u Threshold of training ä Minimal level of exercise needed to achieve desired benefits. u Target zone ä Defines the upper limits of training and the optimal level of exercise. u FITT formula ä Frequency, Intensity, Time, and Type ä Manipulate these factors to produce an individualized exercise program. u Needs and goals of individual ä Program should meet the goals of the individual

18. Goal u Initial goal of weight-loss therapy is to reduce BW by approximately 10% from baseline within 6 months of therapy. u For patients with BMIs in the 25 to 35 range, a decrease of 300 to 500 kcal/d results in weight losses of about 0.23 to 0.45 kg/wk and a 10% loss in 6 months (Table 1). u For more severely obese patients with BMIs greater than 35 kg/m2, deficits of up to 500 to 1,000 kcal/d lead to weight losses of about 0.45to 0.90 kg/wk and a 10% weight loss in 6 months

19. Goal u The minimal amount of accumulated physical activity generally recommended to achieve a degree of protection from chronic diseases (30 min/d) is insufficient for most persons to maintain BW in the desirable BMI range (18.5–24.9 kg/m2). Exercise Nutrition Cognitive- behavior therapy

20. FITT Formula u Frequency: Start from 3d/wk Goal is 5d/wk or near all d/wk Prim Care Clin Office Pract 36 (2009) 379–393

21. FITT Formula u Intensity: between 45% to 85% of the maximal heart rate - maximal heart rate : By subtracting a patient’s age from 220 (for men) or 226 (for women), a maximal heart rate can be calculated. - Adjustments in intensity should be made based on a person’s baseline level of fitness, with lower- intensity exercise recommended for less fit individuals. Prim Care Clin Office Pract 36 (2009) 379–393

22. FITT Formula u Time: -Start from 30 min/d Goal is 45 min/d and more -For weight maintenance 60- 80min/d

23. FITT Formula u Type: Aerobicactivities (Jogging,Running,Walking,Dancing,Biking,Swimming) u Aerobic EX is the choice because of cardio respiratory effects - large muscle groups are used in continuous rhythmic activity for prolonged periods. - Aerobic activities provide isotonic exercise, whereby skeletal muscle fibers shorten in length with little change in tension. -During isotonic exercise, heart rate and cardiac output increase, but peripheral vascular resistance falls. -During isometric exercise muscle tension increases with little change in fiber length, producing a marked increase in peripheral vascular resistance and blood pressure with little increase in cardiac output u Patient should enjoy the activity u an exercise prescription should contain recommendations for resistance training and flexibility training at least twice a week

24. Flexibility u Maximum range of motion possible at a joint u Can prevent muscle injuries; improve low- back pain

25. Strengthening exercise u Maintenance of proper posture; protect joints. u Production of power to enhance performance u Prevention of osteoporosis

26. Exercise for geriatric u 2 main problem in Ex prescription in elderly - Differences in aerobic and functional capacity - Reduced strength and endurance of muscles associated with aging and chronic Dis. Flexibility training Resistance training Aerobic exercise.

27. Exercise for obes children u An exercise prescription similar to that for adults appears appropriate for childrenolder than 6 years. u Children should enjoy the EX. u 6omin/d,moderate intencity,near all day/weak, Aerobic EX u Limit resistant training

28. Summery u 45 min/d or more of aerobic Ex in 5 or preferably all days of the week with intencity of 45% to 85% of MaxHR u Strength-developing and flexibility activities at least twice a week.

29. Thank you