Obesity

References

• [1] ‘2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults’, p. 37.
  [2] K. Wasserman, Ed., Principles of exercise testing and interpretation: including pathophysiology and clinical applications, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012.
  [3] ‘2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults’, p. 37.
  [4] American College of Sports Medicine, D. Riebe, J. K. Ehrman, G. Liguori, and M. Magal, Eds., ACSM’s guidelines for exercise testing and prescription, Tenth edition. Philadelphia: Wolters Kluwer, 2018.
  [5] P. Parto and C. J. Lavie, ‘Obesity and Cardiovascular Diseases’, Current Problems in Cardiology, vol. 42, no. 11, pp. 376–394, Nov. 2017, doi: 10.1016/j.cpcardiol.2017.04.004. .

• IDENTATION !!! activity have benefits regarding the following health outcomes/diseases: HEAD SUBSECTION SUBSECTION2 HEAD2 HEAD4 SummaryExercise is recommended as a treatment for overweight and obeso prevent weight gain and maintain weight loss.Cardiovascular and musculoskeletal comorbidities should be analysed before initiating exercise. An ECG and/or an Exercise testing should be performed according to the CV risk.Exercise recommendations are similar to Exercise Recommendations for Adults (18-64 years) but: 1) exercise time should be ≥ 250-300 min/week and low articular load exercises should be preferredInformation for patientshttps://www.exerciseismedicine.org/eim-in-action/health-care/resources/rx-for-health-series/Definition [1]Obesity: an excessive accumulation of fat tissue that results in increased health risks.Pathophysiology [2]Low exercise capacity due to increased body mass (specially thoracic and abdominal mass):Cardiac impairmentIncreased resting stroke volume and decreased reserve stroke volumeVentilatory impairment:Low vital capacityHypoxemiaPeripheral atelectasisCardiac impairmentIncreased resting stroke volume and decreased reserve stroke volumeIncreased resting stroke volume and decreased reserve stroke volumeVentilatory impairment:Low vital capacityHypoxemiaPeripheral atelectasisLow vital capacityHypoxemiaPeripheral atelectasisDiagnosis [3-4]Diagnosis can be done according to:BMIOverweight: BMI 25-29,9 kg/m2Obesity grade 1 (mild): BMI 30-34,9 kg/m2Obesity grade 2 (moderate): BMI 35-39,9 kg/m2Obesity grade 3 (severe): BMI ≥ 40 kg/m2Overweight: BMI 25-29,9 kg/m2Obesity grade 1 (mild): BMI 30-34,9 kg/m2Obesity grade 2 (moderate): BMI 35-39,9 kg/m2Obesity grade 3 (severe): BMI ≥ 40 kg/m2Waist circumference:♂ ≥ 102 cm♀ ≥ 88 cm♂ ≥ 102 cm♀ ≥ 88 cm% Fat massNormal:♂ ≥ 18 - 24%♀ ≥ 25 - 31%Obesity♂ ≥ 25%♀ ≥ 32%Normal:♂ ≥ 18 - 24%♀ ≥ 25 - 31%♂ ≥ 18 - 24%♀ ≥ 25 - 31%Obesity♂ ≥ 25%♀ ≥ 32%♂ ≥ 25%♀ ≥ 32%Treatment [3]Lifestyle interventionsDietExercise.Adjuvant therapies (e.g. drugs, bariatric surgery):based on BMI and comorbidities. based on BMI and comorbidities"Obesity paradox": [5]obese patients with other cardiovascular (CV) risk factors have better prognosis that normal weight patients with CV risk factors.After weight lost, patients with BMI < 35 kg/m2 and heart failure (HF) with reduced ejection fraction have:higher mortality and morbidityincreased in symptomsa decreased functional capacity .higher mortality and morbidityincreased in symptomsa decreased functional capacity .Weight loss is recommended only if BMI > 35 kg/m2Exercise trainingPre-exercise screeningClinical Evaluation [4]Comorbidities screeningCardiovascularMusculoskeletalCardiovascularMusculoskeletalGoal settingTarget a 3-10% weight reduction in 3-6 months.Brief nutritional interventionaim a reduction in intake of 500-1000 kcal/dayTarget a 3-10% weight reduction in 3-6 months.Brief nutritional interventionaim a reduction in intake of 500-1000 kcal/dayaim a reduction in intake of 500-1000 kcal/dayECG [4]Low-to-moderate intensity exercise:consider for risk stratification, according to the CV risk.consider for risk stratification, according to the CV risk.Vigorous-intensity exercise:recommended.recommended.Exercise testing [2, 4]Low-to-moderate intensity exercise:consider for risk stratification, according to the CV risk.consider for risk stratification, according to the CV risk.Vigorous-intensity exercise:recommended.recommended.Cardiopulmonary exercise testing (CPET) findings:High VO2max, but low VO2max/kg.Low ventilatory threshold 1 (VT1)Possible resting hypoxemia, low chronotropic response and hypertensive response.High VO2max, but low VO2max/kg.Low ventilatory threshold 1 (VT1)Possible resting hypoxemia, low chronotropic response and hypertensive response.Exercise prescription [4]Aerobic exerciseRecommendations are similar to Exercise Recommendations for Adults (18-64 years) but:Exercise time should be increased to ≥ 60 min/day or ≥ 250-300 min/weekLow articular load exercises (specially in the lower limbs) should be preferredE.g. cycling, swimming, rowing, yogaExercise time should be increased to ≥ 60 min/day or ≥ 250-300 min/weekLow articular load exercises (specially in the lower limbs) should be preferredE.g. cycling, swimming, rowing, yogaAerobic exercise is the most studied type of exercise in obese patientsPrevents weight gain and aids weight loss maintenance.There's controversy about its effects on weight loss (grade B evidence) in comparison with caloric restriction (grade A evidence).There's controversy about its effects on weight loss (grade B evidence) in comparison with caloric restriction (grade A evidence).There's a dose-dependent effect< 150 min/week: minimal weight loss≥ 150 min/week: moderate weight loss (~2-3 kg)225-420 min/week: maximal weight loss (5-7,5 kg)< 150 min/week: minimal weight loss≥ 150 min/week: moderate weight loss (~2-3 kg)225-420 min/week: maximal weight loss (5-7,5 kg)Resistance exerciseRecommendations are similar to Exercise Recommendations for Adults (18-64 years)It doesn't seem to prevent lean mass loss nor to reduce resting metabolic rate.Flexibility trainingSimilar to Exercise Recommendations for Adults (18-64 years)Balance trainingSimilar to Exercise Recommendations for Adults (18-64 years)Exercise modalitiesNot analysed yet.