What research tells the clinician regarding exercise for obesity.

1. What research tells the clinician regarding exercise for obesity. By: Diane Brett, Mike Seidel and Mike Halbach

2. Korean Circulation Journal Volume 40 Pgs. 179-184 April 2010 Article #1 “The effects of an exercise program on anthropometric, metabolic, and cardiovascular parameters in obese children.” Authors: YunHee Lee, MD, Young Whan Song, MD, et al.

3. Article #1 Purpose To compare cardiovascular and metabolic factors before and after an exercise program on obese children and to evaluate their physical fitness levels after.

4. Article #1 Methods • 54 obese children • 45 males, 9 females • Ages 12-14 • 60 minutes sessions • 3 times a week • 10 week exercise program divided into 3 groups • 1. Aerobic exercise: activities including soccer, basketball, football, jumping rope, etc. • 2. Combined exercise: circuit weight training, aerobic activity, etc. • 3. Control group

5. Article #1 Results Increases Decreases Waist circumference Systolic BP LDL levels I mile run times • HDL levels • VO2 Max • Grip strength • Long jump • Curl ups

6. Article #1 Discussions • A regular exercise program which incorporates aerobic and anaerobic activities is shown to be the best combination to decrease BMI, weight and blood pressure in obese children. • Limitations to study: • Short program- only 10 weeks • Small number of participants - only 54

7. Article #1 Conclusions • Incorporating an exercise program into a child’s routine at least 3 days per week can be effective in: • Treating childhood obesity • Decreasing the risk for metabolic syndrome in the future.

8. Article #2 “Variability in adherence to an unsupervised exercise prescription in obese women.” International Journal of Obesity Volume 32 Pgs. 837-844 2008 Authors: RC Colley, AP Hills, TM O’Moore-Sullivan, IJ Hickman, JB Prins and NM Byrne

9. Purpose Article #2 To measure the consistency of a specific exercise prescription (1500 kcal/week) by subjecting unsupervised exercise energy expenditure (ExEE) in obese women.

10. Article #2 Methods • Participants who had a body mass index of >30kg/m were placed into a hospital-based lifestyle intervention trial lasting for 16 weeks aimed to increase insulin sensitivity by weight loss and physical activity. • Heart rate monitors were used to track exercise compliance in the subjects. • Sub maximal treadmill protocols were used as well.

11. Article #2 Results • 37 women were recruited; however, insufficient HR monitoring data in eight women- not included in analysis. • Compliance with using the HR monitors was 78%. • Two goals; change in body weight and in fat mass. • 9 participants reached both goals • 14 neither • 6 reached weight loss goal without achieving the ExEE goal.

12. Article #2 discussions This study demonstrated that exercise is affiliated with both overall weight loss and fat mass loss in a group of obese women participating in an organized lifestyle intervention program.

13. Article #2 Conclusions • The main finding of this study was that obese women have a highly variable and, on average, modest adherence to a prescription of 1500 kcal/week of unsupervised exercise. • In fact, the women in the present study achieved, on average, just over half of the prescribed dose.

14. Article #3 “Cardiovascular fitness in Obese versus Non-obese 8-11-year-old boys and girls.” Journal Title: Research quarterly for Exercise and Sport Volume 79 2008 p. 356-362 Authors: M. AlysiaMastrangelo, Edward C. Chaloupka, and Peter Rattigan.

15. Purpose Article #3 The currency of obesity among children and adolescents in the U.S. has nearly doubled in the past two decades, with 20-30% of children and adolescents now classified as obese.

16. Article #3 Methods • All students asked to complete the MRW (mile run/walk) in as short a time as possible. • School nurses were asked to take height and weight measurements to compute BMI (kg/m^2) and to help with cardiovascular fitness calculations.

17. Article #3 Results • Non-obese boys and girls were able to perform the test better than the others that were classified as obese. • Non-obese boys finished the MRW 2 min 35s faster than obese boys. • Non-obese girls finished the MRW 1 min 29s faster than the obese girls.

18. Article #3 Discussions • This test is shown to be easily administered and a cost and time efficient field test. Each participant’s time was individually compared to the 50th percentile by age and gender.

19. Article #3 Conclusions • Non-obese children performed better than obese children in assessing cardiovascular fitness. This indicates a lower susceptibility to obesity-related diseases in childhood and on to adulthood.

20. Article #4 “Physical Activity Attenuates the genetic predisposition to obesity in 20,000 men and women in epic-Norfolk prospective study.” Journal Title: PLoS Medicine Volume 7 August 2010 Authors: Shengxu Li, Jing Hua Zhao, Jian’an Luan, Ulf Ekelund, Robert Luben, Kay-Tee Khaw, Nicholas Wareham and Ruth Loos

21. Purpose Article #4 To assess the influence of a physically active lifestyle on the genetic predisposition to obesity in a large population based study.

22. Article #4 Methods • Assessed individuals with a genetic predisposition to see if increasing daily physical activity could modify the risk of becoming obese. • 20,430 subjects • Ages 39-79 years old • Examined 12 DNA characteristics that predisposed people to becoming obese. • A genetic predisposition score was given to each subject which correlated to an increase in BMI. • Each individual assessed their level of physical activity (from occupational to leisure activities). • There was an initial assessment and a final assessment 2 years later.

23. Results Article #4 Active vs. Inactive Change in BMI Physical activity significantly modified the outcome of the genetic predisposition score on BMI. The physical activity questionnaires placed participants into an active group and inactive group. After 2 years, the active groups change in BMI did not change much, however the inactive groups average change in BMI was significant.

24. Article #4 Discussions • Confounding Variables: • questionnaire was not a true measure of physical activity • participants could have lied on questionnaire • not every participant came to final assessment (only 15,000 of 20,000)

25. Article #4 Conclusions • Having a physically active lifestyle can modify the genetic predisposition to obesity. • The genetic predisposition to obesity can be reduced by 40% by having a physically active lifestyle. • Individuals who are predisposed to obesity would benefit more from physical activity than genetically protected individuals.

26. Article #5 “Risk Of Obesity in Relation to Physical Activity Tracking from Youth to Adulthood.” Journal of the American College of Sports Medicine Volume 38 pg. 919-925 2006 Authors: Xiaolin Yang, Risto Telama, Jorma Viikari, and Olli T. Raitakari

27. Purpose Article #5 1. To test the hypothesis that obesity in adults is related to physical activity as a child. 2. To test how changes in physical activity from youth to adulthood effects adulthood obesity.

28. Article #5 Methods • Questionnaires and physical examinations were given to participants in both 1980 and 2001 • A physical activity index was made to categorize the participants into active, moderately active, inactive groups. • Compared the PAI numbers from 1980 to 2001 to come up with 4 categories: • persistently active • increasingly active • decreasing active • persistently inactive • Used BMI, skin fold measurements, and waist circumference

29. Article #5 Results • Physical activity in youth is inversely associated with both measures of obesity in females, but only BMI in males. • In both sexes, participants that were persistently active or increasingly active had lower WC values than those who were decreasingly inactive. • Women who had been decreasingly active and persistently inactive had a higher probability of being overweight than women who were persistently active. • Both men and women who were decreasingly active were more likely to have mild and severe abdominal obesity in adulthood than those who were persistently active.

30. Article #5 Discussions • Confounding variables: questions of education, occupation, residence, marital status, number of children, and smoking habits. • Physical activity over 21 years was significantly related to abdominal obesity in men and women. • Participants who reported that their physical activity level had decreased were at an increased risk of being obese in adulthood. • Being decreasingly inactive is a stronger risk factor for obesity than being persistently inactive. • Unexpected result: people who were persistently inactive were not at higher risk of obesity than people who were persistently active • Limitations: diet and perceived intensity differences in youths and adults

31. Article #5 Conclusions • Physical activity history over 21 years was significantly related to abdominal obesity in both men and women (more significantly in women). • Physical activity patterns are important in determining whether or not an adult will be obese. • Regular participation in physical activity from youth to adulthood could help to prevent obesity in adults.

32. Overall Conclusions of Articles • Each article provides evidence for the importance of physical activity in the determination of obesity. • Some find that adding exercise to a person’s daily routine will decrease risk for obesity and reduce BMI. • Other articles find that physical activity patterns throughout a persons life help determine the risk of obesity. • Although other factors are present, physical activity seems to be the most important factor in determining obesity. • For an obese person, it is important to put them on an exercise routine • For children, it is vital to be active in order to help prevent obesity in the future.