Exercise

prescription in
obesity
CONTENT
 WHAT IS OBESITY??
 EVALUTION
 EXERCISE PRESCRIPTION
-goals
-Components of Exercise
Prescription
 References
WHAT IS OBESITY??

 Obesity is a medical condition in

which excess body fat has
accumulated to the extent that it
may have an adverse effect on
health, leading to reduced life
expectancy and/or increased
health problems.
 People are considered obese
based on the BMI, hip/ waist ratio
and other methods.
risk factors of obesity.

 Heart disease
 Type 2 diabetes
 Obstructive sleep apnea
 Hormonal disturbance
 High blood pressure
 High blood cholesterol
 Osteoarthritis
EVALUTION
 Pre-exercise Evaluation History

 TESTS

-Body mass index(BMI)

-Graded Exercise Testing
-Skin fold thickness and
- waist-to-hip circumference ratios,
-techniques such as ultrasound,
computed tomography, and
magnetic resonance imaging(MRI).
Body mass index(BMI)

< 18.5 • underweight

18.5–24.9 • normal weight

25.0–29.9 • overweight
30.0–34.9 • class I obesity
35.0–39.9 • class II obesity
≥ 40.0 • class III obesity
Graded Exercise Testing

 It is recommended before any

moderate to high intensity
exercise, especially if:
- Age is > 40 yrs.
- With diabetes for > 10 yrs
duration.
- Presence of any CHD risk factors
and peripheral vascular disease.
Skin fold Measurements
 The principle behind this technique is
that the amount of subcutaneous fat is
proportional to the total amount of
body fat.

 It is assumed that close to one third of

the total fat is located subcutaneously.

 Therefore, regression equations

used to convert sum of skinfolds to
percent body fat must consider these
variables for greatest accuracy.
Generalized Skinfold Equations
MEN
 Seven-Site Formula (chest, midaxillary, triceps,
subscapular,abdomen, suprailiac, thigh)
Body density =1.112 - 0.00043499 (sum of seven
skinfolds)+ 0.00000055 (sum of seven
skinfolds)2 -0.00028826 (age)
[SEE 0.008 or 3.5% fat]
• Three-Site Formula (chest, abdomen, thigh)
Body density = 1.10938 - 0.0008267 (sum of three
skinfolds)+ 0.0000016(sum of three
skinfolds)2 -0.0002574 (age)
[SEE 0.008 or 3.4% fat]
• Three-Site Formula (chest, triceps, subscapular)
Body density = 1.1125025 - 0.0013125 (sum of three
skinfolds)+0.0000055 (sum of three
skinfolds)2-0.000244 (age)
[SEE 0.008 or 3.6% fat]
WOMEN
 Seven-Site Formula (chest, midaxillary, triceps,
subscapular,abdomen, suprailiac, thigh)
Body density =1.097 - 0.00046971 (sum of seven
skinfolds) +0.00000056 (sum of seven
skinfolds)2 - 0.00012828 (age)
[SEE 0.008 or 3.8% fat]
• Three-Site Formula (triceps, suprailiac, thigh)
Body density =1.099421- 0.0009929 (sum of three
skinfolds) +0.0000023 (sum of three
skinfolds)2- 0.0001392 (age)
[SEE 0.009 or 3.9% fat]
• Three-Site Formula (triceps, suprailiac, abdominal)
Body density =1.089733 - 0.0009245 (sum of three
skinfolds) +0.0000025 (sum of three
skinfolds)2 -0.0000979 (age)
[SEE 0.009 or 3.9% fat]
waist-to-hip circumference
ratios
 The waist-to-hip ratio (WHR) is the
circumference of the waist divided
by the circumference of the hips
and has been used as a simple
method for determining body fat
distribution
 A waist/hip circumference ratio
greater than 0.90 for men and 0.85
for women.
 WAIST CIRCUMFERENCE cm (IN)

RISK CATEGORY WOMEN MEN

Very low <70 cm (27.5 in) <80 cm (31.5 in)

Low 70–89 (28.5–35.0) 80–99 (31.5–39.0)

High 90–109 (35.5–43.0) 100–120 (39.5–47.0)

Very high >110 (43.5) >120 (47.0)

EXERCISE PRESCRIPTION
GOALS
 Decreases body fat.
 For morbidly obese, enhances the
ability to carry on the Activity of
Daily Living.
 Improves chronic disease risk
factor profile.
 Enhances functional capacity.
 Improves cardiovascular fitness.
Components of Exercise
Prescription
Mode (Type of exercise)

Frequency of participation

Duration of each exercise

Intensity of exercise

Progression of Exercise Program

Mode (Type of exercise)

 When choosing the exercise

modalities to be included
- an exercise program,
-the individual’s goals,
- physical ability,
-health status, and available
equipment
 AEROBIC PHYSICAL ACTIVITIES that
involve the large muscle groups.
-Low impact moderate-intensity
aerobic activity (walking, cycling,
swimming, recumbent exercise).
-Avoid jogging and running. It
stresses knee, hip and ankle joints.

 RESISTANCE-TRAINING EXERCISE
Frequency of participation
 >5 d/wk to maximize caloric
expenditure

 Exercise duration and frequency

are more important than intensity
of exercise.
Duration of each exercise
 30–60 min / day to total 150
minutes per week
-progressing to 300 minutes per
week, of moderate physical
activity.
-150 minutes of vigorous physical
activity.
 5 to 10 min warm up and cool
down period.
 Components of an exercise session

Warm up Exercise period Cool down

period 30-60 min period
5-10 min 5-10 min
 Intensity of exercise
 it can be quantified on the basis
of
- training heart rate(THR)
- metabolic equivalent (MET)

 THR (the karvonen method)

TRH75%= HR rest + 0.75 (HR max – HR rest))

 Also according to
75 % of Maximal Heart Rate or 75% of
Heart Rate Reserve

-Maximal Heart Rate = 208 – ( 0.7 X

age (yrs))
-Maximal Heart Rate = 220 – age
(yrs))
-Heart Rate Reserve =HR max – HRrest
 Metabolic Equivalent (MET):The
amount of energy expended
during exercise relative to the
energy expenditure during rest.

- Energy expenditure during rest = 1 MET

= 3.5 ml of O2 / kg. min
= 1 kcal / kg. hr
PHYSICAL ACTIVITY INTENSITY IN MET

Light: Less than 3 MET

Moderate: 3 – < 6 MET

Vigorous: > 6 MET

Moderate & Vigorous Intensity
Physical Activities

 Moderate: Brisk walking, swimming,

Volleyball, Slow aerobics, Moderate
cycling Gardening, Tennis-double,
Badminton etc..

 Vigorous: Jogging, Running, Tennis-

single, Basketball, Rope skipping,
Squash, Fast aerobics, Fast cycling,
Stepping, Soccer, etc
 Moderate- to vigorous-intensity
physical activity should be
encouraged.
-Moderate :- 40%–60% VO2max or
HRR)
-vigorous-exercise :- 50%–75%
VO2max or HRR)
Progression of exercise
program
Exercise Prescription before
and after Bariatric Surgery
Pre-Op:
Start exercise prior surgery.
Individualized exercise plan.

Post Surgery- Day 1:

Sit in chair with assistance and
walk in room 2-3 times.
Post Surgery- Day 2-Day 7:
Walk 3-5 min , 4- 6 times a day.

Post Surgery- Week 1 to Week 2:

Continue walking while increasing
walking time to 5-15 min , 3 times per
day.

Post Surgery- Week 2 to Week 4:

Continue walking while increasing
walking time to 10-15 min , 3 times
per day.
Post Surgery- Month 1 and on:
Walk 30 min to 1 hour , at least 5
times a day.
May begin weight training with
doctor approval.
REFERENCE
 Kenneey ,wilmore ,costill, physiology
of sport and exercise, 5th edition
 Hill JO, Drougas H & Peters JC (1993)
Obesity treatment: can diet
composition play a role? American
College of Physicians 119,694-697.
 Jakicic JM, Donnelly JE, Pronk NP,
Jawad AF & Jacobsen DJ(1995)
Prescription of exercise intensity for
the obese patient the relationship
between hr, Vo, and perceived
exertion.International Journal of
Obesity 19, 382-387.
 ACSM guidelines for exercise
testing and prescription 8th edition
 William D. McARDLE KATCH ,
exercise physiology, 4th edition