of physical activity and energy balance in preventing weight gain. Weight gain is caused by an imbalance between energy intake (food) and energy expenditure . (activity) [Figure 2]. . inactivity, sedentary lifestyle and obesity in the European Union. Int J Obes sedentary behaviors in relation to risk of obesity and type 2. Weight Loss Related to a Diet Intervention, an Exercise Intervention, and a Diet + The Energy Balance subcommittee used the Physical Activity Guidelines for . a dose-response relationship between physical activity and body weight or BMI. body weight in a nationally representative sample in the European Union. Download Citation on ResearchGate | WEIGHT MANAGEMENT, of energy needs and expenditure, healthy nutrition, fluid balance.
The magnitude of weight loss reported in these studies is consistent with earlier reviews on this topic by Wing 71 and the Expert Panel of Clinical Guidelines for the Treatment of Obesity 1. Conclusions Most of the available literature indicates that "more is better" when it comes to the amount of physical activity needed to prevent weight regain following weight loss.
However, the literature has some considerable shortcomings regarding the appropriate research design needed to directly address this question. Given these limitations, the estimated gross energy expenditure needed to achieve weight maintenance following substantial weight loss is about 31 kilocalories per kilogram week or 4.
Key words included adults, exercise, physical activity, obesity, adiposity, weight, and BMI. Eight systematic reviews or meta-analyses also were reviewed for pertinent references. Studies that investigated special populations e. To be included, studies had to target a period of weight loss followed by a period of weight maintenance using physical activity as the strategy for preventing weight regain.
Eight randomized trials met the above criteria and were used for this review. Of the eight studies, only three had a design in which participants were randomized after weight loss and only two used a control group. Three observational or prospective cohort studies were identified that met the above criteria and were used for this review. Four position papers or reports also were used as references. It is generally accepted that individuals can lose weight but most cannot maintain significant weight loss.
Because it has an energy equivalent, physical activity is universally promoted as a necessary component of strategies to maintain weight loss 1 ; 75 ; Indeed, physical activity is often cited as the best predictor of weight maintenance after weight loss 77 ; A systematic review of physical activity to prevent weight regain subsequent to weight loss was completed by Fogelholm and Kukkonen-Harjula The majority of studies included in this review were observational studies and studies of individuals who were randomized at baseline to exercise or no exercise, or to different levels of physical activity.
Follow-up varied from several months to several years and generally showed that individuals who engaged in exercise experienced less regain than those individuals who did not, and those individuals who engaged in greater amounts of physical activity experienced less regain than those who did more moderate levels.
Only 3 studies used a design in which individuals were randomized to physical activity after weight lossand the results were inconsistent, showing that physical activity had an indifferent, negative, or positive effect on prevention of weight regain. Despite the accepted concept that physical activity is necessary for successful weight maintenance after weight loss, the amount that is needed remains uncertain. These guidelines were provided for health promotion and disease prevention.
However, they were widely interpreted to also be useful for weight management. However, recent evidence suggests that greater levels of physical activity may be necessary to prevent weight regain after weight loss.Energy Balance and Weight Control
For example, individuals in the National Weight Control Registry who have maintained weight loss have shown levels of energy expenditure equivalent to walking about 28 miles a week Retrospective analyses of these data were performed to determine the level of physical activity that provided maximum differentiation between gainers and maintainers.
Based on these analyses, it was determined that individuals would need to expend about 4. Jakicic and colleagues 73 ; 84 and Andersen and colleagues 85 provided data from randomized trials showing that individuals who performed large amounts of physical activity maintained weight loss better at follow-up of 18 months, 12 months, and 12 months, respectively, than did those doing smaller amounts of physical activity. In particular, Jakicic and colleagues 73 ; 84 showed very little weight regain in individuals who performed more than minutes per week of moderate-intensity physical activity.
Ewbank and colleagues 72 also found similar results 2 years after weight loss by very-low-energy diet. Retrospectively grouping participants by levels of self-reported physical activity, individuals who reported greater levels i.
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However, it is important to note that individuals in all 3 studies above were grouped into physical activity categories retrospectively and were not randomly assigned to those groups after weight loss. Thus, the amount of physical activity was self-selected and therefore does not provide clear evidence for the amount needed to prevent weight regain.
To explore the effects of levels of physical activity greater than those normally recommended in weight management programs, Jeffery and colleagues 86targeted energy expenditures of 1, kilocalories per week and 2, kilocalories week for 18 months in 2 groups of participants; these levels were randomly assigned at baseline.
At 6 months, weight loss did not differ between the groups, but there were significant differences at 12 and 18 months weight maintenance follow-up, with the 2, kilocalories per week group showing significantly greater weight losses 6. The energy equivalent for walking for the 2, kilocalories per week group and 1, kilocalories per week group was about 3.
This study showed that greater levels of physical activity resulted in significantly lower levels of weight regain.
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However, the results must be interpreted with caution, as the percentage of individuals meeting the targeted energy expenditure varied greatly, and the behavioral interventions were not equal.
In general, large volumes of physical activity are needed to prevent weight regain in those who have lost a great deal of weight. Studies by Ewbank and colleagues 72Jakicic and colleagues 73and Schoeller and colleagues 74 indicate that the volume of physical activity needed for that purpose is approximately 31 MET-hours per week or 4.
Conclusions A dose-response relation exists between volume of physical activity and decreases in total and abdominal adiposity in overweight and obese individuals. In the absence of coincident caloric restriction, aerobic physical activity in the range of 13 to 26 MET-hours per week results in decreases in total and abdominal adiposity that are consistent with improved metabolic function. Thirteen MET-hours per week is equivalent to walking at a 4 mile per hour pace for minutes per week or jogging at a 6 mile per hour pace for 75 minutes per week However, larger volumes of physical activity e.
The evidence thus far suggests that abdominal fat loss with increased physical activity is proportional to overall fat loss. Definitions The obesity phenotype that conveys the greatest health risk of metabolic disorders, such as the metabolic syndrome and type 2 diabetes, is one that favors an accumulation of adipose tissue in the abdominal region. Regular physical activity is recognized as an effective method of preventing excessive weight and fat gain throughout adulthood, and although physical activity is commonly prescribed to reduce overall obesity, the influence of exercise induced weight loss on abdominal adiposity is not clear.
Abdominal adiposity is characterized several ways in the scientific literature. Although less precise than the imaging measures, the waist circumference measured in centimeters and usually defined at the level of the lowest rib is the most widely-used anthropometric measure of abdominal adiposity and therefore has the most clinical utility of all these measures.
Evidence obtained using the Scientific Database was supplemented with recently-published scientific papers and review articles. Favorable body composition changes reduced fat mass and increased lean mass occur with the adoption of regular physical activity — even among individuals aged 75 years and older, and evidence suggests that current activity is more protective than past activity 87 ; What is not clear at this time is the amount and type of activity necessary to result in meaningful alterations in abdominal fat, which in turn can preserve or improve metabolic function.
Unfortunately, few large-scale RCTs have been directed toward this question. The data that do exist are from relatively small RCTs and controlled intervention studies. Several RCTs and controlled interventions report the benefits of moderate- to vigorous-intensity aerobic exercise to overall improvements in body weight, body fat, and lean mass in middle-aged and older adults 7 ; 8 ; The data are equivocal, however, with regard to the ability to significantly alter regional distribution of body fat with endurance training ; 54 ; 91 ; In general, aerobic exercise, without dieting, appears to have a beneficial effect on overall and abdominal adiposity.
However, the exercise dose necessary to result in these alterations is rather high. In Irwin and colleagues 7minutes per week of moderate- to vigorous-intensity physical activity performed over 12 months resulted in a reduction in subcutaneous fat and intra-abdominal fat of 5.
Together, these findings ; 93 and others 6 support the contention that in the absence of coincident caloric restriction, aerobic physical activity in the range of 13 to 26 kilocalories per kilogram per week results in decreases in total and abdominal adiposity that are consistent with improved metabolic function. However, as mentioned above, when more physical activity is done per week e. A recent study employing 45 minutes of resistance exercise training twice weekly also reports small, yet favorable changes in total and abdominal fat 56 in middle-age and older adults, but not in younger, non-obese women The benefits of resistance training may be most noticeable among obese and older populations, who typically have the greatest amount of abdominal fat.
Generally, short-term less than 6 months exercise interventions will have a positive effect on body composition. However, the magnitude of these alterations in body fat or lean mass may be of limited biological significance In general, the amount of adiposity present in study subjects at baseline will affect the amount of fat lost with a given intervention. Indeed, studies employing overweight or obese subjects 7 ; 8 ; 56 ; 92 ; 93 report greater improvements in body composition than those studies using subjects of normal weight 48 ; Also important is the dose-response relation highlighted by Ross and colleagues 93 between exercise-induced weight loss and fat loss — that is, greater total weight loss will result in greater fat loss 7 ; Overall, regular participation in aerobic physical activity causes decreases in both total and abdominal adiposity, changes that are consistent with improved metabolic function.
The greater the volume of physical activity, the larger the change in adiposity. Conclusions Some evidence indicates that the amount of physical activity needed to maintain a constant weight differs between men and women and increases with age.
This may be due to a number of physiologic and behavioral factors that also vary by sex and by age. However, the evidence is not sufficient to recommend differential physical activity prescriptions based on sex or on age alone. Studies identified using the Scientific Database were supplemented by recently-published or in press scientific papers and review articles.
Findings presented here were limited to studies having a forward study design i. Sex The prevalence of obesity is higher among women compared with men, particularly among women from ethnic minority groups 4 ; Although women report less physical activity than men, it is not clear whether this is actually so, or whether it is a consequence of measurement error resulting from the low sensitivity of traditional physical activity surveys 83 ; 98 ; In any case, potential sex differences in the influence of physical activity on weight stability are important to consider in maximizing the utility of future public health guidelines.
Cross-sectional and longitudinal epidemiologic studies generally have demonstrated inverse associations between physical activity and weight gain in both men and women e. Dose-response relationships have been somewhat less consistent in women than in men.
However, as stated previously, this may be attributable to measurement error associated with self-reported data ; Indeed, objective measurements of energy expenditure e. The few intervention studies that included both men and women along with sex-specific analyses report weight or fat losses only in menno change in either sex 67or similar changes in both men and women e.
It is likely that differences in findings among these intervention studies reflect dissimilarities among study protocols. However, even within particular study samples, observed sex differences in weight loss responses to exercise can be attributed to a number of factors.
For instance, several highly controlled laboratory-based intervention studies have noted that women are more resistant to weight loss or may require greater energy expenditure compared with men to maintain a healthy body weight 54 ; ; Indeed, this suggests that a similar absolute energy expenditure e.
This may be due to a greater proportion of less lipolytically responsive gluteofemoral adipose tissue in younger and middle-aged women than in men of the same age. Animal studies also have observed a sex dimorphism in the control of energy homeostasis that might be attributed to a differential interaction between adiposity hormones and food intake control systems in the brain ; These biological sex differences in responsiveness to weight change may be difficult to discern in large community-based interventions or at the population level, however, due to measured or unmeasured sex differences in: Because a number of other physiological body mass, peak aerobic capacity or behavioral factors cigarette smoking, drinking, hormone replacement therapy also may vary between men and women, studies that measure sex differences in weight loss responses to exercise must be careful to control for these covariables either by matching in experimental designs or by appropriate statistical adjustments when feasible.
Age Because the risk of chronic disease increases markedly with sedentary lifestyles and with age, the public health burden associated with inactivity is substantial among middle-aged and older adults In general, lower levels of physical activity are associated with higher body weight and body fat in middle-aged and older adults 4 ; 87 ; The epidemiologic studies to date provide clear longitudinal evidence linking habitual physical activity to the prevention of excess weight gain in both men and women ; and this is true even in older age.
Although the effect sizes from these observational studies appear small, over the lifespan these small savings in excess weight gain accumulate into net savings that are quite meaningful with regard to minimizing the risk of obesity-related disorders.
Moreover, the longitudinal epidemiologic evidence suggests that as people progress from young adulthood to old age, they require increasing amounts of daily energy expenditure to maintain a constant body weight 37 ; ; ; More than likely, this is due to a combination of physiologic e. An active lifestyle also is beneficial in preventing weight loss, an increasingly important concern for the oldest sectors of the population those older than 85 years because of its relation to metabolic disorders and functional ability.
Several observational studies have demonstrated the longitudinal benefits of even modest levels of physical activity on preventing excess weight loss in older age, presumably through the maintenance and preservation of lean mass Among intervention studies, training protocols are too variable and sample sizes are often too small to establish dose-response relations between changes in weight and activity type, duration, and intensity for different age subgroups. Nonetheless, some intervention studies have demonstrated statistically significant improvements in various weight-related outcomes e.
The magnitude of improvement observed in many of these intervention studies is similar, but is smaller than what is often observed in younger populations given the same relative exercise dose.
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This may be especially true for older women. This contrasts with the similar obesity rates among men: Greater obesity implies a lesser ability to maintain weight and avoid weight gain, which may be associated with less physical activity, more physical inactivity, or both. Understudied Populationsfor a detailed discussion of this topicspecifically exploring the possible need for different recommendations to promote weight maintenance also is warranted.
Differences in the energy cost of physical activity, such that some ethnic groups would appear to derive lesser benefits for weight maintenance at the same level of physical activity e. Differences in the relative contribution of physical activity and excess calories energy expenditure versus energy intake to weight gain, such that some ethnic groups would receive less benefit than others because physical activity contributes less to the overall equation However, recent studies have demonstrated that these physiological differences may, in fact, be explained by racial variations in body morphology e.
Rationale The Energy Balance subcommittee used a search strategy to generate articles from the Physical Activity Guidelines for Americans Scientific Database all age group combinations except youth, with weight and BMI as the outcome of interest, excluding studies focused on weight loss. This type of activity cannot be planned, taught, or incorporated into one's day.
You either have it or you don't. The TEF does play a key role in weight gain and weight loss but is an uncontrollable factor, the manipulation of which does not contribute to changes in body composition 6. Energy metabolism in human obesity.
Note that in the above example body weight is expressed in kilograms kg and not pounds. To convert your weight in pounds to kilograms, divide by 2. Programmed Exercise Programmed exercise is a great way to burn calories at an accelerated rate and is recommended to maintain a healthy lifestyle 2 ; however, much to the fitness enthusiast's surprise, not everyone enjoys programmed exercise. In some cases people may go a little overboard with their fitness routines see cartoon above.
Each of these actives requires caloric expenditure and can be done in a playful, fun manner, rather than a pre-programmed sometimes painful manner. Fidgeting Frequent fidgeting is a trait you either have or you don't. We do not have the time to think about trying to fidget during the day to burn calories.
The picture above of the "Mini Treadmill" was taken from a Bud Light ad in which they satirically pointed out that 10 calories of carbohydrates could be easily burned by utilizing their mini treadmill. Trying to fidget throughout the day to lose weight makes about as much sense as using the mini treadmill. We should instead, try to focus on things we can control. Is exercise effective for weight loss with ad libitum diet? Energy balance, compensation, and gender differences.
Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Resistance to exercise-induced weight loss: