Elsevier

Cardiology Clinics

Volume 19, Issue 3, 1 August 2001, Pages 459-470
Cardiology Clinics

EXERCISE IN WEIGHT MANAGEMENT OF OBESITY

https://doi.org/10.1016/S0733-8651(05)70229-0Get rights and content

Obesity has become an important burden for the health system of industrialized countries and must be regarded as a serious public health issue in our time. Obesity is associated with reduced life expectancy,38 and it is now well recognized that increased body fat is associated with heart disease, stroke, hypertension, dyslipidemia, type 2 diabetes mellitus, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems and numerous cancers (endometrial, breast, prostate and colon).2, 21 The American Heart Association has stated that obesity is a major modifiable risk factor for heart disease.40, 42 This article reviews basic regulatory aspects of human adipose tissue metabolism with implications for the cardiologist in terms of exercise prescription and the role of exercise and aerobic physical training in the management of obesity.

Section snippets

EPIDEMIOLOGY

The incidence of obesity in the United States has increased progressively since 1960.104 In the United States and in Europe, the incidence of being overweight and obese have reached epidemic proportions.2, 61 Furthermore, in the past decade, the percentage of overweight and obese individuals in the United States and in some countries in Europe has increased to over 50% of adults aged 20 years or older.61, 104 Childhood obesity is also an alarming problem, and opportunities for physical activity

DEFINITION

Overweight is defined as a body mass index (BMI; weight in kilograms divided by the square of height in meters) of 25 kg/m2 to 29.9 kg/m2 and obesity as a BMI ≥30 kg/m2.2 All overweight and obese adults aged >18 years with a BMI ≥25 kg/m2 are considered at risk for developing cardiovascular comorbidities.84 However, it is important to emphasize that obesity is characterized by a remarkable metabolic heterogeneity.27, 28, 29 Thus, the challenge for the health care professional and the

ADIPOSE TISSUE METABOLISM AND CARDIAC ADAPTATION IN OBESITY

Numerous enzyme pathways and hormones are implicated in adipose tissue metabolism.83 Lipoprotein lipase (LPL) is synthesized in adipose tissue and, by hydrolysing circulating triglyceride-rich lipoproteins, is important in the provision of fatty acids for their uptake and storage as triglycerides (TG).39 Insulin increases adipose tissue LPL.83 There are site differences in the regulation of lipolysis in vitro and in vivo in normal-weight subjects.63 In normal-weight men, adipose tissue LPL

ADIPOSE TISSUE METABOLISM AND EXERCISE

Whereas α-adrenergic mechanisms regulate lipolysis at rest, β-adrenergic activity controls the lipolytic rate during exercise.10 Free fatty acid (FFA) availability is maximal at 25% to 40% of

o2max, and shifts in energy substrate mobilization and utilization occur as exercise intensity increases, particularly at intensities above 70% to 80% of
o2max.92 Therefore, above a certain degree of intensity, the muscle preferentially operates on glycogen stored in situ. However, aerobic physical

Dyslipidemia

As we have alluded to previously, some very obese individuals may nevertheless show a fairly normal metabolic risk factor profile, whereas others may present all the features of an atherogenic and diabetogenic metabolic profile27, 28, 29, 64 (see Box 1). Indeed, there is remarkable metabolic heterogeneity among obese subjects, and the presence of visceral obesity generally worsens the metabolic portrait. Accumulation of visceral fat has been associated with type 2 diabetes mellitus,

INFLUENCE OF PHYSICAL ACTIVITY ON ADIPOSE TISSUE METABOLISM

There is an inverse relationship between the amount of daily physical activity and body weight. Exercise requires energy, and the two main sources of fuel for muscle contraction are carbohydrates (CHO) and lipid. The major source of lipid energy for muscle is the TG stored in adipose tissue, but available as FFA. Exercise is one of the most potent physiological stimuli for lipolysis; it is higher during exercise in trained subjects than that reported during critical illness57 or even after 84

EXERCISE PRESCRIPTION

The minimal objectives of a weight loss and management program are: to prevent further weight gain, to reduce body weight, and to permanently maintain a lower body weight. Regular physical activity is a well-recognized tool for long-term weight maintenance because it contributes to increased energy expenditure through a caloric deficit (although generally small) contributing to weight loss.102 Although epidemiologic studies have suggested that weight cycling could be associated with an elevated

SUMMARY

Obesity is a chronic metabolic disorder associated with CVD and increased morbidity and mortality. When the BMI is ≥ 30 kg/m2, mortality rates from all causes, and especially CVD, are increased by 50% to 100%. There is strong evidence that weight loss in overweight and obese individuals improves risk factors for diabetes and CVD. Additional evidence indicates that weight loss and the associated diuresis reduce blood pressure in both overweight hypertensive and nonhypertensive individuals,

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    Address reprint requests to Paul Poirier, MD, FRCPC, Laval University School of Pharmacy, Institut de Cardiologie et de Pneumologie, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Québec, Canada, G1V 4G5

    Support has been provided by grants from The Québec Heart Institute and Le Fond de Recherche en Santé du Québec (PP), the Canadian Institutes for Health Research (J-PD), the Natural Sciences and Engineering Research Council (J-PD), the Canadian Diabetes Association (J-PD), and the Heart and Stroke Foundation of Canada (J-PD).

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