For Women With Very Low Body Weight, High Amounts of Exercise Can Result in

Abstruse

There is evidence to support that depression fitness and concrete activeness, excess body weight, and excess abdominal fatness are associated with increased wellness risk. Moreover, testify exists to support that sufficient levels of physical action tin significantly improve torso weight, fatness, and wellness run a risk. Concrete activity has been shown to have a small effect on body weight that is typically <three% of initial body weight, only has an additive effect when combined with dietary brake. Moreover, physical activity has been shown to be an important behavioral factor for enhancing long-term weight loss and minimizing weight regain; all the same, this may crave relatively loftier doses of physical activeness that arroyo 300min/week. Physical activity may meantime reduce abdominal adiposity, and which may serve as a pathway by which there is also an improvement in health-related gamble factors for various chronic diseases. There are important areas of research that require further investigation, with item need to further examine the dose of physical activeness that significantly affects these health outcomes. Moreover, there is a need for improved interventions to promote the adoption and long-term maintenance of physical activity, which tin can lead to improved weight control, abdominal adiposity, and chronic affliction hazard factors. Time to come research is besides needed to understand the physiological/metabolic pathways and mechanisms that explicate the influence of physical activity on long-term regulation of body weight.

Excess body weight has been associated with an increase in health-related diseases such every bit eye disease, diabetes, certain forms of cancer, musculoskeletal disorders, and other related problems ((i)). The morbidity and mortality of obesity-related conditions accept resulted in an increment in the associated wellness-intendance cost of these conditions. For example, in the United States, the estimated toll associated with obesity exceeds $117 billion annually ((2)). Thus, it is of import to consider intervention opportunities to lower the health adventure associated with obesity, which in plow may reduce the health-care costs associated with these conditions. 1 of the lifestyle-intervention opportunities that has been shown to exist effective is physical action due to its importance in trunk-weight regulation and its independent upshot on related health outcomes.

There have been numerous studies that have reported on the importance of concrete action for weight control. These studies accept focused on prevention of weight gain, successful weight loss, and the prevention of weight regain. The involvement in physical action as a lifestyle strategy to combat the increasing prevalence of overweight and obesity stems from the fact that it is the one method that can be consistently used to increase energy expenditure. As highlighted by Ravussin and Bogardus ((3)) physical activeness is the most variable component of total daily free energy expenditure. Therefore, it is important to understand the contribution of an increase in energy expenditure resulting from physical activeness on weight loss, long-term weight-loss maintenance, and the prevention of weight gain. Optimal weight command through physical activity may too contribute to reductions in abdominal adiposity and reductions in metabolic risk.

Does Physical Activity Affect Health Risk Independent of Body Weight?

There is a growing body of scientific literature to support the effect of physical activity on health-related outcomes contained of trunk weight. For instance, information from the Aerobics Middle Longitudinal Study has consistently shown an inverse relationship betwixt fitness and bloodshed in adults regardless of level of weight status (normal weight, overweight, obese) ((4),(five),(6),(7)). The pattern of an inverse association between health risk and physical action, independent of weight status, is also supported by a number of other investigations ((viii),(9),(x)). Lee et al. ((11)) have also reported an association between improved risk cistron profiles and fitness at varying levels of abdominal adiposity measured by either computed tomography or magnetic resonance imaging.

Despite these findings, there is evidence to support the position that concrete activeness does not completely alleviate the negative health outcomes associated with obesity ((viii),(9),(10)). This decision is consistent with the findings of Fly et al. ((12)) in a written report of over 5,000 individuals with type 2 diabetes, which demonstrated that selected adventure factors were significantly influenced by weight status (e.k., systolic blood pressure) whereas others were significantly influenced past fitness (eastward.1000., HbA1_c, ankle brachial alphabetize, Framingham Gamble Score). Moreover, both concrete activity and a smaller waist circumference accept recently been shown to be associated with classification of enhanced metabolic health (presence of 0 or 1 cardiometabolic abnormality) in obese individuals ((13)). These results may advise that it is important to intervene on both physical inactivity and excess body weight to have the greatest improvement in health outcomes.

A potential expanse for additional enquiry related to the independent effect of concrete activity on health risks in obese individuals may lie in the study of individuals with Course II (BMI: 35.0–39.9 kg/mⁱⁱ) or III obesity (BMI ≥twoscore kg/k²). Church et al. ((5)) acknowledged that there are express data on the relationship between fitness and weight status among individuals with Course 2 or III obesity when examining data from the Aerobic Eye Longitudinal Report due to few individuals with this weight status being classified as fit. This observation is confirmed past Wing et al. ((12)) in analysis of data from the Expect Alee Written report in which merely 10% of individuals with Grade III obesity were in the highest 40% for fitness classification, with only ane.viii% of individuals in the highest tertile for waist circumference being in the highest fitness category. These findings may suggest that it may be difficult and uncommon for individuals in the highest categories of obesity and/or waist circumference to be able to accomplish sufficiently loftier levels of fitness to better health outcomes contained of concomitant reductions in trunk weight. Once more, this may suggest that for some individuals, it is important to arbitrate on both physical inactivity and backlog body weight to have the greatest improvement in wellness outcomes.

Outcome of Physical Activity on Weight Loss

To effectively reduce body weight information technology is widely accepted that a negative energy remainder needs to be nowadays; whereas, to maintain weight loss and forestall weight gain, energy balance needs to be present. Thus, physical activity can be an important intervention to achieve desired trunk-weight regulation. Still, the effect of physical activeness solitary on reductions in torso weight may exist somewhat modest. For instance, in a written report of overweight and obese adults at gamble for the onset of blazon 2 diabetes, Wing et al. ((14)) compared interventions consisting of diet alone, concrete activity alone, and the combination of nutrition plus concrete activity. Results following the initial half-dozen-calendar month intervention period revealed weight losses of 9.ane, 2.1, and x.4% in these intervention conditions, respectively, with weight loss in the physical activeness lonely conditioning beingness significantly less than the weight loss in the nutrition solitary and nutrition plus physical action conditions. In a study of men, Wood et al. ((fifteen)) reported that weight loss in response to physical action was 3.0 and four.0 kg at 7 and 12 months, which was significantly less than the vii.6 and 7.2 kg weight loss observed in response to a dietary intervention. In response to a 12-calendar week intervention, Hagan et al. ((xvi)) report significantly less weight loss for men and women (0.6%) in response to concrete action alone compared to 8.4 and 5.v% in response to dietary restriction alone, and compared to 11.4 and vii.5% in response to the combined effects of nutrition plus physical action. These data announced to indicate that physical activity has a small-scale impact on short-term weight loss in overweight and obese adults.

Donnelly et al. ((17)) examined supervised physical activeness of 45min/day on v days/calendar week over a 16-month menstruation in overweight and Course I obese adults. The results of this written report demonstrated that when dietary intake is unchanged, for men concrete action resulted in weight decrease of 5.2 kg vs. a 0.v decrease observed in non-physical-activity control men. In dissimilarity, physical activity for women blunted weight gain with weight increasing by 0.six kg in exercising women vs. a 2.nine kg increase in not-physical-activity control women. The concrete activity also resulted in significant reductions in abdominal adiposity every bit measured by computed tomography. For males, nonsignificant differences at 16-calendar month that favored the physical action vs. the control atmospheric condition were observed for visceral fat (departure of 9.9 cm²), subcutaneous fat (difference of 23.two cm²), and total fat (difference of 33.two cmⁱⁱ). For females, differences favoring the physical activity vs. the control group at 16-months were observed for visceral fat (deviation of eight.six cm²; P = 0.88), subcutaneous fat (deviation of 53.three cm^two; P = 0.02), and total fat (deviation of 61.9 cm²; P = 0.04) with the blueprint of modify in abdominal adiposity mirroring the observed changes in body weight between genders. These gender differences may be a consequence of the supervised physical activity resulting in different energy expenditures, with the average energy expenditure for each physical activity session 667 kcal (half dozen.7 kcal/kg of fatty-gratis mass) in men vs. 438 kcal (5.four kcal/kg fat-free mass) in women ((18)). Thus, the observed gender differences may be a result of differences in energy expenditure resulting from physical action. Thus, it volition be important for hereafter studies to examine whether clamping free energy expenditure volition upshot in like changes in trunk weight in men and women.

The scientific testify presented in the Physical Action Guidelines Commission Report in the United States (http:www.health.govPAguidelines) confirms that physical alone typically results in weight change of <3% of initial body weight, with absolute weight loss ranging from ∼0.5 to 3.0 kg. This is consistent with the magnitude of two.4 kg reported by the National Heart, Lung and Blood Institute's Expert Panel ((1)), and the ane–2 kg reduction in body weight reported in a review conducted by Wing ((nineteen)).

This pocket-sized magnitude of weight loss resulting from physical activeness lonely is consistent with the definition of "weight stability" as defined by Stevens et al. ((20)), suggesting that a greater dose of physical activeness or physical activity combined with reductions in energy intake may be required to elicit greater reductions in trunk weight. Notwithstanding, information technology is important to note that even modest reductions in trunk weight may be beneficial for reducing cardiometabolic take a chance. For example, Wing et al. ((14)) reported that a 2.3 kg reduction in body weight over a period of 24 months from physical activity or the combination of diet plus physical action decreased the relative chance of developing diabetes by ∼30% in individuals initially identified with normal or impaired glucose tolerance.

Effect of Physical Activity on Long-Term Weight Loss and Weight-Loss Maintenance

Although physical activeness may take modest effects on initial weight loss, physical activity may exist a critically of import strategy for the maintenance of weight loss. Jakicic et al. ((21)) accept recently reported that relatively high doses of physical activity may exist of import for the long-term maintenance of weight loss. In a secondary analysis of data from a study of adult women, it was reported that individuals who achieved a weight loss of 10% of initial body weight that was maintained at 24 months were engaging in ∼275min/week of physical action above baseline levels. Achievement of a x% weight loss is consistent with the weight-loss target recommended past the National Center, Lung and Blood Institute for overweight and obese adults ((1)). The importance of improved long-term weight loss in this study appears to too bear on sustained reduction in abdominal adiposity equally measured by waist circumference, sagittal diameter, waist-to-hip ratio (Figure 1).

Changes in (a) waist circumference, sagittal diameter, and hip circumference and (b) waist-to-hip ratio by 24-month weight loss (data adapted from Jakicic et al. ((21))).

These results confirm the importance of relatively high doses of concrete action to maintain weight loss as reported by others ((22),(23),(24),(25),(26)), and may confirm recommendations for weight-loss maintenance that have been reported ((27),(28),(29),(30)). This is of importance because the maintenance of initial weight loss has been challenging. For example, information technology has been reported that following weight loss, ∼33–50% of initial weight loss is regained in the ensuing 12–eighteen months ((31)). However, physical activity appears to play a key role in the long-term maintenance of weight loss, which may ultimately result in sustained improvements in metabolic risk.

The National Weight Control Registry (NWCR) is a registry of individuals who take self-reported to accept lost at to the lowest degree xxx pounds and accept maintained this weight loss for at to the lowest degree ane twelvemonth (ref. (25)). This provides interesting data related to the behaviors of individuals who have successfully lost and maintained significant weight loss. Of interest is the pattern of physical activity in this cohort. Klem et al. ((25)) report that individuals in the NWCR cocky-report participating in ∼ii,800 kcal/calendar week of leisure-time concrete action to maintain their body weight. McGuire et al. ((32)) further highlight the importance of physical action for weight-loss maintenance by reporting that individuals in the National Weight Control Registry who regained weight later 1 year in this registry reported greater decreases in energy expenditure when compare to those individuals who continued to maintain their significant weight loss.

Evidence of the importance of physical activity for maintenance of weight loss is non limited to the National Weight Control Registry. For case, Kayman et al. ((33)) reported that 76% of individuals who had maintained significant weight loss reported using physical activity every bit a weight-loss strategy vs. 36% of individuals who relapsed from initial weight loss. When comparing individuals who had maintained a weight loss of 15 pounds vs. those who had relapsed, Gormally and Rardin ((34)) institute that 54% of maintainers reported regular concrete activity vs. 36% of those who had relapsed. Moreover, Leser et al. ((35)) reported that self-reported physical activity was inversely correlated (r = −0.53) with weight regain at a 3-year follow-upward to a very-depression-calorie diet intervention for weight loss. Physical activity was also shown to exist predictive of maintenance of weight loss post-obit an intervention involving pharmacotherapy ((36)). Despite these findings, it is important to notation that physical activity is only i component of successful weight-loss maintenance, with Jakicic et al. ((37)) reporting that long-term weight-loss success is accomplished through a constellation of behaviors, one of which is physical activity.

Effect of Concrete Activity on Prevention of Weight Gain

As reported by Jakicic et al. ((21)), ∼27% of individuals engaged in a behavioral weight-loss intervention achieved a 10% weight loss at 24 months, with 49% of individuals achieving at least 5% weight loss. This confirms the difficulty of achieving long-term weight loss equally reported by others ((31)). Thus, information technology may be of import to focus intervention efforts on prevention of weight gain and obesity, and physical activity may be an of import component of intervention efforts to prevent weight gain.

Results from cross-exclusive and prospective observational studies appear to support the need for adequate levels of physical activity to prevention weight gain. Lee et al. ((8)) demonstrated from cross-sectional data that individuals who report levels of physical activeness that are consequent with the consensus public health guidelines take a lower body weight than those not reporting this level of physical activity ((8)). A potential limitation of this study is the self-reported assessment of physical action. Ball et al. ((38)) followed a cohort of 8,726 immature women (age = 18–23 years) for a period of iv years to examine predictors of weight maintenance. Results from this study demonstrated that 41% of these young women gained weight over this period of time, which was defined as gaining ≥five% of their initial body weight. Individuals who reported spending ≥33h/week sitting were 17–20% more likely to gain weight compare to those reporting sitting <33h/week. These results are consistent with other studies that have demonstrated sedentary behavior such every bit television viewing to exist associated with increasing levels of trunk weight and obesity ((39)). A potential mechanism for this relationship is that a college level of television viewing is associated with a lower resting metabolic rate in children ((xl)). Nonetheless, an culling hypothesis would exist that sedentary activities reduce the opportunities for physical activity, which results in an overall reduction in energy expenditure. Therefore, boosted studies are required to conclusively make up one's mind how sedentary behaviors such as sitting and television viewing contribute to weight proceeds and obesity.

In a study that used an objective measurement of cardiorespiratory fitness, it was reported that weight gain was attenuated over a four-year period as cardiorespiratory fitness increased over this same observation period ((41)). Cardiorespiratory fitness has been shown to improve with increased levels of concrete activity. Therefore, these findings may reflect an increase in physical activity, with this contributing to the prevention of weight gain. In a study to examine predictors of weight gain in the Healthy Worker Project, French et al. ((42)) reported that over a two-year menstruum the boilerplate weight gain was 0.vi kg for women and 0.iv kg for men. Results of this study demonstrated that an increase of i walking session per week was predictive of a decrease in body weight over the 2-yr period of 0.eight kg and 0.four kg in women and men, respectively. However, these levels of concrete activity combined with dietary behaviors and weight-loss history accounted for ∼9–x% of the weight loss observed.

There is also evidence from intervention studies supporting the importance of physical activity in the prevention of weight gain. Sherwood et al. ((43)) report that concrete activity was predictive of weight change in the Pound of Prevention Study. Results of multivariate cross-sectional analysis revealed that moderate-intensity physical activeness was predictive of less weight gain in this study; whereas multivariate prospective analysis revealed that high-intensity concrete activity was predictive of weight alter over the 3-yr catamenia. When examining information from intervention studies, the effect of physical activity on weight gain may result from the non-physical-activity control group gaining a modest amount of weight with those individuals participating in physical activity losing a modest amount of weight. For example, Slentz et al. ((44)) reported that concrete activity resulted in a pocket-size decrease in body weight and measures of trunk fatness, whereas command subjects not participating in physical action had a modest increase in body weight in the STRIDDE Study.

Summary

In summary, based on the scientific evidence, it appears that physical action can exist an important component of intervention efforts for body-weight regulation. These findings are of import as it appears that there is a concurrent reduction in intestinal adiposity with weight loss resulting from concrete activity. However, the weight loss achieved with physical activity lone appears to be pocket-size and is typically <3% of initial torso weight. Even so, the addition of physical activeness to a dietary intervention tin can result in improved weight loss compared to what is accomplished through dietary modification alone. Moreover, information technology appears that concrete activity is a key lifestyle behavior in longer term weight loss and the maintenance of weight loss. Nevertheless, as summarized in the Physical Activity Guidelines Advisory Committee Written report, additional research is needed to fully sympathise the contribution of physical action to body-weight regulation ((45)). In general, these areas of research include the following:

one. Appropriately designed and powered studies are needed to understand the outcome of different modes, intensities, duration, and frequencies of physical action on weight loss, weight stability, and weight regain.

two. There may exist a need for further inquiry to understand how demographic characteristics such every bit age, gender, race/ethnicity influence the outcome of concrete activity on weight loss, weight stability, and weight regain.

3. In that location is a need for further enquiry to be conducted that focus specifically on behavioral strategies that improve the adoption and long-term maintenance of physical activity in overweight and obese adults.

four. At that place is a need to examine whether the dose of physical activeness that promotes improved long-term outcomes of weight control is different from the dose of physical activity that results in improvements in chronic disease risk factors and the onset of chronic illness beyond the entire range of body weight including those with severe obesity (e.g., Form II and Form Three obesity).

Disclosure

J.One thousand.J. has received consulting fees and grant support from BodyMedia, Proctor & Gamble, Costless & Clear, UPMC Wellness Plan.

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