Guest blog post written by Dr. David Creel
Imagine a pharmaceutical commercial touting that a drug improves mood, makes sleep more restful, helps our memory and concentration, decreases our potential of developing dementia, lowers our risk of colon and breast cancer, and makes our bones stronger. But there’s more--the health benefits of this product can also treat or help prevent the negative consequences of obesity. It improves insulin sensitivity, can normalize blood pressure, and prevents cardiovascular disease. And just when you were waiting to hear a long list of potential side effects spoken at the speed of an auctioneer’s voice, the commercial ends. Of course, I’m not referring to a drug, I’m talking about physical activity. Like some medications, exercise prevents disease, heals ailments, and gives us the best chance of living a long, energetic life. It’s an inexpensive endeavor with few side effects to speak of.
Despite
these benefits, only 20 percent of American adults get the recommended 150
minutes per week of moderate to vigorous physical activity. Unfortunately,
those with obesity are even less likely to exercise regularly. In our upcoming
#obsm chat, we will discuss the role of physical activity in health and weight
loss.
What does exercise mean to those with excess weight?
How
many times have we heard it, or said it-- “To lose weight you’ve got to change
the way you eat… and begin exercising.” For those with obesity, healthy eating
and exercise are sometimes closely linked together. Go on a diet
and start exercising, break the diet and stop. It’s a unique coupling of
behaviors that has not been studied extensively. Think about it--we rarely hear
someone say they blew their diet and stopped brushing their teeth or wearing
their seatbelt. I would argue that professionals have put too many eggs in one
basket when it comes to exercise. We’ve failed to promote exercise for all of
the general health reasons noted above and instead hyper-promote it for weight
loss.
Does exercise help with weight loss?
From
a calorie perspective, exercise often pales in comparison to dietary changes.
Many studies have shown that in the short-run exercise contributes little to
weight loss. However, data from many longer-term studies show that 250 minutes
per week or more of physical activity predicts who will maintain weight lost
through traditional approaches. We know much less about the impact of exercise
on weight loss after bariatric surgery.
Exercise challenges for those with obesity
When
people feel like they must exercise to lose weight, it is easy to focus on intensity and burning calories rather the enjoyment of
the activity and how much better we feel when we do it. This obviously makes
exercise less appealing. As the severity of obesity increases, poor
cardiorespiratory fitness, orthopedic issues, and ill-fitting exercise
equipment further limit the variety of exercises people can perform. In fact,
activities of daily living can be quite strenuous. According to a recent study we conducted, a majority of bariatric surgery
candidates would be unable to push mow a small yard. Among those with a BMI of
50 or higher, two-thirds would find vacuuming to be at least moderately
difficult.
How can we help people exercise more?
Some
believe that weight loss leads to exercise. However, research doesn’t fully
support this. Even after bariatric surgery, physical activity only increases
modestly, on average. One study showed that 25% of patients were less
active one year after bariatric surgery than before. So, if weight loss won’t
do it, how can we promote more activity? Studies examining motivational factors for exercise
suggest that people maintain an exercise regimen for at least one of the
following two reasons:
1) They like it.
Therefore, it makes sense to help people find activities they enjoy and can fit
into their lifestyle.
2) They do it for
the benefit. These are the people who view exercise as a medication.
Most
people don’t enjoy the act of taking meds, but many do it anyway. If we can
help people with exercise adherence in similar ways as we do with medication
adherence (buying into its importance, scheduling, etc.) we may be on to
something.
No
matter our weight, many things compete for our time. Those with obesity have
additional layers of physical and sometimes psychological obstacles to regular
physical activity. In the upcoming Twitter chat (April 8, 2018 at 9 pm EST) we will discuss the following
questions:
- What type of exercise-related education/resources help people with obesity?
- What are common mistakes healthcare professionals make when promoting exercise among those with obesity?
- For patients, does it help when your provider “practices what they preach?” For professionals, do you think you’re a better exercise counselor if you are committed to physical activity?
- High Intensity Interval Training has become quite popular. What are the pros/cons of undertaking this type of exercise for those with excess weight?
- How do you motivate patients/clients -- or what motivates you -- to move more? Any success stories?