Obesity

Question 1

Respond to acute exercise (4)

Answer 1

1. Reduced maximal capacity and VO2 peak
   
   • Consider protocols with lower initial workload (-3 METS) and smaller increment (0,5-1,0 METS)
2. Musculoskeletal limitation
   
   • May warrant adaptation of testing modality (leg cycle ergometer with oversized seat or arm ergometer)
3. Overestimation of BP if cuff size is too small
4. Presence of comorbid condition (dysipidmia, HTN, Impaired glucose tolerance)
   
   • Consider their effect (+meds) on acute exercise

Question 2

Exercise testing (5)

Answer 2

1. Presence of comorbid conditions may impact need for medical screening before exercise
2. Consider timing of meds if comorbid conditions
3. Consider adapting testing modality and/or protocol if musculoskeletal limitation or reduced exercise capacity
4. Appropriate cuff size should be used
5. Standard termination criteria for VO2max may not apply

Question 3

BENEFITS (4)

However… (2)

Answer 3

1. less 150min/week of PA promotes minimal weight loss
2. more 150min/week of PA result in modest weight loss (2-3kg)
3. more 225-420min/week results in a 5-7,5kg weight loss
4. May need 200-300min/week prevent weight regain
5. Considerable inter-individuality variability
6. Certain individuals compensate; they increased their energy intake when they undertake an exercise program

Question 4

Precautions (2)

Weight loss recommendation (6)

Answer 4

1. If musculoskeletal limitations, consider lower intensities, lower-impact activities (e.g. walking), and/or non-weight-bearing activities (cycling, water aerobics, etc.)
2. Avoid extreme heat because of risk of hyperthermia

See weight loss recommendations

1. Target min reduction in BW of at least 3%-10% of initial body weight over 3-6 months
2. Reduced EI and fat intake; 500 to 1000 kcal/d reduction = elicit weight loss of 1-2lb/week
3. weigh loss of 5-10% require more support with nutrition, exerc and behavioral intervention. If do not respond to lifestyle change, meds or surgery may be appropriate
4. Medically indicated very low calories diet with energy restriction of up to 1 500 kcal/d better than EI reduction. Needs meal plan and only for selected ind and for short period of time.
5. Enhance communication with health care prof., dietitian, EP, with a following weight loss.
6. Target changing eating and exercise behaviors b/c sustained change result in long term weight loss and maintenance.