Adults with overweight or obesity should be encouraged and supported to increase their physical activity and reduce sedentary time. Exercise recommendations should be individualised according to the person’s health status, physical capacity, mobility, preferences, previous activity level and treatment goals.
Physical activity is an important component of comprehensive obesity management. It improves cardiorespiratory fitness, muscle strength, physical function, mobility, metabolic health and quality of life. These benefits may occur even in the absence of substantial weight loss. Exercise should therefore not be evaluated solely on the basis of changes in body weight. [1–4]
Before starting an exercise programme, relevant medical conditions, symptoms, medications, mobility limitations, musculoskeletal problems and the person’s risk of falls should be assessed.
Most people can begin with light- to moderate-intensity physical activity and gradually increase the duration, frequency and intensity. Medical assessment should be considered before vigorous exercise in people with:
Exercise should be postponed in the presence of an acute illness or an unstable medical condition, such as unstable angina, decompensated heart failure, a haemodynamically significant uncontrolled arrhythmia, acute myocarditis, acute pulmonary embolism or another condition in which physical exertion may be unsafe. Appropriate clinical evaluation and stabilisation are required before exercise is resumed. (ACSM)
Activities should be adapted when joint pain, osteoarthritis, neuropathy, balance problems or severe deconditioning are present. Suitable lower-impact options may include walking, cycling, swimming, water-based exercise, seated exercise or use of an elliptical trainer.
Adults should aim for:
The activity should preferably be distributed throughout the week. Moderate-intensity activity typically increases breathing and heart rate while still allowing the person to speak in complete sentences. Examples include brisk walking, cycling, swimming and dancing. (World Health Organisation)
People who are currently inactive should begin with manageable amounts, such as 5–10 minutes at a time, and progress gradually. Any amount of physical activity is better than none, and shorter periods accumulated throughout the day can contribute to the weekly total. (World Health Organisation)
Higher volumes of aerobic exercise are generally associated with greater reductions in body fat and may support long-term weight maintenance. However, the weight response varies considerably between individuals. Exercise alone usually produces only modest average weight loss and should generally be combined with appropriate nutritional and behavioural interventions when weight reduction is an agreed treatment goal.
Approximately 150–200 minutes of moderate-intensity aerobic exercise per week may produce modest reductions in weight and body fat. Volumes of approximately 200–300 minutes per week, and sometimes more, may be needed to support weight maintenance after weight loss. Higher volumes should be introduced progressively and according to the individual’s health, capacity and preferences. (PMC)
Resistance or muscle-strengthening exercise involving all major muscle groups should be performed on at least 2 non-consecutive days per week.
The programme may include:
Beginners should initially focus on correct technique, controlled movements and exercises that can be performed safely. Training volume and resistance should be increased gradually.
Resistance training improves muscle strength and physical function and can help preserve lean body mass during weight loss. It may increase or maintain muscle mass, particularly when combined with adequate nutrition. This is especially important for older adults and for people undergoing substantial weight loss.
Although greater muscle mass contributes to resting energy expenditure, the resulting increase in daily energy consumption is usually modest. Resistance training should therefore not be presented as independently preventing weight regain. Its principal benefits include preserving lean mass, improving strength, maintaining mobility and supporting the ability to remain physically active. (PMC)
Older adults and people with impaired mobility or an increased risk of falls should also include multicomponent activities that emphasise balance, coordination and functional strength on at least 3 days per week where appropriate.
Flexibility and mobility exercises may be added to maintain joint range of motion and facilitate daily activities. These exercises complement, but do not replace, aerobic and resistance training. (World Health Organisation)
Long periods of sitting should be interrupted regularly with standing, walking or light activity. Practical strategies may include:
Replacing sedentary time with physical activity of any intensity is beneficial. Light activity can be particularly useful for people who are unable to meet the full exercise recommendations initially. (www.heart.org)
The exercise plan should be developed through shared decision-making and should take account of the person’s goals, interests, daily routine, cultural background, financial resources and access to suitable facilities.
Activities that are enjoyable, accessible and realistic are more likely to be continued over the long term. Progress should be monitored using outcomes that matter to the individual, such as:
Referral to a physiotherapist, exercise physiologist, sports physician or appropriately qualified physical-activity specialist may be helpful for people with severe obesity, substantial functional limitations, complex comorbidities or uncertainty regarding safe exercise prescription.
Physical activity should form part of a long-term, multidisciplinary obesity-management plan. It may be combined with nutritional therapy, behavioural interventions, pharmacotherapy and metabolic or bariatric procedures according to the person’s clinical needs and preferences. (NICE)