EXERCISE IN WEIGHT 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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2020, Preventive MedicineCitation Excerpt :This is because the relationship between energy intake and expenditure is complex, and it includes interactions between energy intake, physical activity, thermic effect of food, and basal energy expenditure (Bray, 2008). Factors such as age, gender, ethnic background, body mass index (BMI), and genetics also play a role in an individual's weight change response to exercise (Luke et al., 2007; Poirier and Despres, 2001; Rankinen et al., 2010). In fact, Thomas and colleagues determined that the discrepancy between expected weight loss and actual weight loss was mostly attributed to modest increases in exercise energy expenditure and compensatory increases in caloric intake (Thomas et al., 2012).
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).