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Guidelines on Overweight and Obesity: Electronic Textbook
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Physical Activity

An increase in physical activity is an important component of weight loss therapy since it leads to increased expenditure of energy. Increased physical activity may also inhibit food intake in overweight patients. Physical activity can also be helpful in maintaining a desirable weight. In addition, sustained physical activity has the benefit of reducing overall CHD risk beyond that produced by weight reduction alone.

Several experts believe that a progressive decrease in the amount of energy expended for work, transportation, and personal chores is a major cause of obesity in the United States. These authorities 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. However, this hypothesis is difficult to prove because appropriate data are lacking. Successful restoration of normal weight in many overweight and obese persons requires a higher level of energy expenditure. Increased regular physical activity is the way to achieve this goal of augmenting daily energy expenditure.

Evidence Statement: Physical activity contributes to weight loss, both alone and when it is combined with dietary therapy. Evidence Category A.

Rationale: Increased physical activity alone can create a caloric deficit and can contribute to weight loss. However, efforts to achieve weight loss through physical activity alone generally produce an average of a 2 to 3 percent decrease in body weight or BMI. Even so, increased physical activity is a useful adjunct to LCDs in promoting weight reduction.

Evidence Statement: Physical activity in overweight and obese adults increases cardiorespiratory fitness independent of weight loss. Evidence Category A.

Rationale: There is strong evidence that increased physical activity increases cardiorespiratory fitness, with or without weight loss (346, 363, 369, 375, 401, 404, 406, 432, 434, 445, 447, 448).  Improved cardiovascular fitness also improves the quality of life in overweight patients by improving mood, self-esteem, and physical function in daily activities (572). 

Evidence Statement: Physical activity independently reduces CVD risk factors (Evidence Category A), and reduces risk for cardiovascular disease. Evidence Category C.

Rationale: There is considerable evidence that physical inactivity is an independent risk factor for CVD and diabetes (572). Furthermore, the more active an individual is, the lower the risk. By the same token, increased physical activity appears to independently reduce risk for CVD morbidity and mortality, and diabetes (411, 548, 573, 574).  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 (572).

Evidence Statement: Physical activity contributes to a decrease in body fat, including a modest effect on abdominal fat.  Evidence Category B.

Rationale: Physical activity appears to have a favorable effect on distribution of body fat (572).  Several large cross-sectional studies in Europe (464), Canada (575), and the United States (466-468) showed an inverse association between energy expenditure through physical activity and several indicators of body fat distribution, such as WHR and waist-to-thigh circumference ratio. Fewer data are available on the effects of physical activity on waist circumference, although the ratio changes noted above suggest a decrease in abdominal obesity. 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 (365, 369, 375).  However, it is not known whether the effects of physical activity on abdominal fat are independent of weight loss.

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