7.Obesity and exercise.pdf

11/01/2020 Obesity and therapéutic exercise Definition Chronic disease of multifactorial origin, determined by the interaction of genetic and environmental factors, characterized by the increase in the percentage of body fat, whose magnitude and distribution conditioning individual health and caus...

11/01/2020 Obesity and therapéutic exercise Definition Chronic disease of multifactorial origin, determined by the interaction of genetic and environmental factors, characterized by the increase in the percentage of body fat, whose magnitude and distribution conditioning individual health and cause secundary effects. Obesity is defined as having a BMI of 30 and higher. C 1 11/01/2020 2 11/01/2020 http://www.seedo.es/ 3 11/01/2020 Obesity effects Obesity is the greatest risk of death: Coronary Disease 35% Type 2 diabetes Colorectal cancer 38% 10 points> BMI = < 5 years less life Calculating Resting Metabolic Rate • Resting Metabolic Rate (Calories/Day) = 370 + (21.6 x fat free mass in kg) • Example: a man weighs 100 kg and has a body fat percentage of 20%. • His fat mass would be 20kg and his lean mass would be 80kg. • His RMR would be 370 + (21.6 x 80) = he burns 2098 calories/day without any exercise! 4 11/01/2020 If your caloric intake from food is……… = (RMR + Calories from Activity + Thermic effect of food) then you will maintain your weight > (RMR + Calories from Activity + Thermic effect of food) then you gain weight < (RMR + Calories from Activity + Thermic effect of food) then you will lose weight Successful Weight Control • It’s not just cutting calories! • There needs to be a balance between the # of calories consumed and the # burned – this requires exercise! • Regular physical activity, along with healthy eating is much more effective at keeping the weight off in the long run than any diet. Combined Approach for Weight Loss • ACSM recommends a combined approach of exercise and moderate caloric restriction for people attempting weight loss • Specific Recommendations for weight loss with exercise: • Frequency 5-7 days • Intensity: initially moderate (40-60% of HRR), then progressing to higher intensity (50%-75% of HRR) • Duration progress from short, easily tolerated bouts to 4560 minutes daily. 5 11/01/2020 Impact of Weight Loss on CV Risk Factors ~5% Weight Loss 5%-10% Weight Loss Glucemic rate Blood Pressure Total Cholesterol HDL Cholesterol Triglycerides Calorie Burners! Activity (kcal/min) 60 kgrs 70 Kgrs 85 Kgrs 95 Kgrs Basketball 7.5 8.8 10.0 11.3 Bowling 1.2 1.4 1.6 1.9 Cycling (10 mph) 5.5 6.4 7.3 8.2 Dancing (aerobic) 7.4 8.6 9.8 11.1 Dancing (social) 2.9 3.3 3.7 4.2 Gardening 5.0 5.9 6.7 7.5 Golf (pull/carry clubs) 4.6 5.4 6.2 7.0 Golf (power cart) 2.1 2.5 2.8 3.2 Hiking 4.5 5.2 6.0 6.7 Jogging 9.3 10.8 12.4 13.9 Running 11.4 13.2 15.1 17.0 Sitting, quietly 1.2 1.3 1.5 Skating (ice and roller) 5.9 6.9 7.9 8.8 Skiing (cross country) 7.5 8.8 10.0 11.3 Skiing (water and downhill) 1.7 5.7 6.6 7.6 8.5 Swimming (crawl, mod. Pace) 7.8 9.0 10.3 11.6 Tennis 6.0 6.9 7.9 8.9 Walking 6.5 7.6 8.7 9.7 Weight Training 6.6 7.6 8.7 9.8 Obesity Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity 6 11/01/2020 Exercise Effects 1. 2. 3. 4. 5. 6. Reduce sarcopenia Avoid the reduction of resting metabolism Improve TA rates, Cholesterol, Triglycerides Increase Strength, physical endurance Improves self-esteem Longest lasting effect Exercise and metabolic effect Exercise Increase oxidative power Increase CHO and Fat metabolism Increase Insuline sensitivty Insulin sensitivity • Low insulin sensitivity can lead to a variety of health problems. The body will try to compensate for having a low sensitivity to insulin by producing more insulin. • However, a high level of circulating insulin hyperinsulinemia is associated with damage to blood vessels, high blood pressure, and heart failure, obesity, osteoporosis and even cancer. 7 11/01/2020 Insulin sensitivity • Exercise, by decreasing insulin resistance, allows the reduction of its associated co-morbidities: HTA, Dlp, DBT, Enf. Coronary • In Obesity, exercise of lowintensity produces an increase in insulin sensitivity, but does not improve the oxidation capacity in the muscle ……is needed Moderate intensity Exercise and fat oxidation • In obesity the fat oxidation is not modified with low intensity exercises. • You will have to use moderate intensity Prescription of Exercise : Evaluation • • • • • • • Current exercise habits : Yes…No Preferred activity Heart disease factors Current medical problems Exercise induced signs : chest pain….. Social support BMI 8 11/01/2020 Prescription of Exercise : SMART • • • • • Specific Measurable Achievable Realistic Timed 10% weight loss in 6 months 2-4 Kgrs /week Short Term 6 m Long Term 12 m. Prescription ARS • Aerobic • Resistance • Stretching 9 11/01/2020 Prescription Short Time phase ( 6 weeks): • Intensity : 50 – 70%VO2 max • Duration : 30 mins • Frecuency: 3 week Prescription Long Time Phase: • 24 months follow up • Intensity : 70 - 80 % VO2 max • Duration : 60 mins • Frecuency: 5/ week 10 11/01/2020 Aerobic Resistance Flexibility Frecuency > 5 week 2 – 3 week 2-3 week Intensity Initial : 40-50% VO2R Progress: 70% Initial :40-50 1 RM Progress : 60-80 1 RM Stretch to the point feeling tightness in large muscles Time 30 mins day 150 mins week Progress 60 mins 2 a 4 sets 85 a 15 reps Major muscles Hold static stretch for 10 -20 secs, 2 -4 reps Type Prolonged activities Free weigths using large muscles: walk, cycling Dynamic and PNF routines 11