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Guidelines on Overweight and Obesity: Electronic Textbook
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Strategies To Increase Physical Activity

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 some 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. The practitioner must decide whether exercise testing for cardiopulmonary disease is needed before embarking on a new physical activity regimen. This decision should be based on a patient's age, symptoms, and concomitant risk factors. 

For most obese patients, physical activity should be initiated slowly, and the intensity should be increased gradually. Initial activities may be walking or swimming at a slow pace. With time, depending on progress, the amount of weight lost, and functional capacity, the patient may engage in more strenuous activities. Some of these include fitness walking, cycling, rowing, cross-country skiing, aerobic dancing, and rope jumping. Jogging provides a high-intensity aerobic exercise, but can lead to orthopedic injury. If jogging is desired, the patient's ability to do this must first be assessed.  The availability of a safe environment for the jogger is also a necessity. 

Competitive sports, such as tennis and volleyball, can provide an enjoyable form of physical activity for many, but again, care must be taken to avoid injury, especially in older people. As the examples listed in Table IV-4 show, a moderate amount of physical activity can be achieved in a variety of ways. People can select activities that they enjoy and that fit into their daily lives. 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). 

Table IV-4: Examples of Moderate* Amounts of Activity

Washing and waxing a car for 45-60 minutes

Less Vigorous, More Time**

aroow

More Vigorous, Less Time

Washing windows or floors for 45-60 minutes
Playing volleyball for 45 minutes
Playing touch football for 30-45 minutes
Gardening for 30-45 minutes
Wheeling self in wheel-chair for 30-40 minutes
Walking 1¾ miles in 35 minutes (20 min/mile)
Basketball (shooting baskets) for 30 minutes
Bicycling 5 miles in 30 minutes
Dancing fast (social) for 30 minutes
Pushing a stroller 1½ miles in 30 minutes
Raking leaves for 30 mintues
Walking 2 miles in 30 minutes (15 min/mile)
Water aerobics for 30 minutes
Swimming laps for 20 minutes
Wheelchair basketball for 20 minutes
Basketball (playing a game) for 15-20 minutes
Bicycling 4 miles in 15 minutes
Jumping rope for 15 minutes
Running 1½ miles in 15 minutes (10 min/mile)
Shoveling snow for 15 minutes
Stairwalking for 15 minutes
*A moderate amount of physical activity is roughly equivalent to physical activity that uses approximately 150 calories of energy per day or 1,000 calories per week.
**Some activities can be performed at various intensities; the suggested durations correspond to expected intensity of effort.

A regimen of daily walking is an attractive form of physical activity for many people, particularly those who are overweight or obese. The patient can start by walking 10 minutes, 3 days a week, and can build to 30 to 45 minutes of more intense walking at least 5 days a week and preferably most, if not all, days (577, 578).  With this regimen, an additional 100 to 200 calories per day of physical activity can be expended. Caloric expenditure will vary depending on the individual's body weight and intensity of the activity (see Table IV-5). This regimen can be adapted to other forms of physical activity, but walking is particularly attractive because of its safety and accessibility. 

Table IV-5: Duration of Various Activities to Expend 150 Kilocalories for an Average 70 kg (154 lb) Adult

Intensity
Activity
Approximate Duration in Minutes
Moderate
Volleyball, noncompetitive
43
Moderate
Walking, moderate pace (3 mph, 20 min/mile)
37
Moderate
Walking, brisk pace (4 mph, 15 min/mile)
32
Moderate
Table tennis
32
Moderate
Raking leaves
32
Moderate
Social dancing
29
Moderate
Lawn mowing (powered push mower)
29
Hard
Jogging (5 mph, 12 min/mile)
18
Hard
Field hockey
16
Very Hard
Running (6 mph, 10 min/mile)
13

Source: Surgeon General's Report on Physical Activity and Health (572)

With time, a larger weekly volume of physical activity can be performed that would normally cause a greater weight loss if it were not compensated by a higher caloric intake. Reducing sedentary time is another approach to increasing activity. Patients should be encouraged to build physical activities into each day. Examples include leaving public transportation one stop before the usual one, parking further than usual from work or shopping, and walking up stairs instead of taking elevators or escalators. 

New forms of physical activity should be suggested, e.g., gardening, walking a dog daily, or new athletic activities. Engaging in physical activity can be facilitated by identifying a safe area to perform the activity, e.g., community parks, gyms, pools, and health clubs. However, when these sites are not available, an area of the home can be identified and perhaps outfitted with equipment such as a stationary bicycle or a treadmill. 

Health professionals should encourage patients to plan and schedule physical activity 1 week in advance, budget the time necessary to do it, and document their physical activity by keeping a diary and recording the duration and intensity of exercise.

Recommendation:  Physical activity should be an integral part of weight loss therapy and weight maintenance. Initially, moderate levels of physical activity for 30 to 45 minutes, 3 to 5 days per week should be encouraged. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week.  Evidence Category B.
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