Harmon S. Jordan, ScD, Karima A. Kendall, PhD, Linda J. Lux, Roycelynn Mentor-Marcel, PhD, MPH, Laura C. Morgan, MA, Michael G. Trisolini, PhD, MBA, Janusz Wnek, PhD

Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN,

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society

Overweight and obesity affects more than 66% of the adult population and is associated with a variety of chronic diseases. Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies. Guidelines of the National Heart, Lung, and Blood Institute (NHLBI) encourage a 10% reduction in weight, although considerable literature indicates reduction in health risk with 3% to 5% reduction in weight. Physical activity (PA) is recommended as a component of weight management for prevention of weight gain, for weight loss, and for prevention of weight regain after weight loss. In 2001, the American College of Sports Medicine (ACSM) published a Position Stand that recommended a minimum of 150 min wk(-1) of moderate-intensity PA for overweight and obese adults to improve health; however, 200-300 min wk(-1) was recommended for long-term weight loss. More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss. To this end, we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain, for weight loss, and prevention of weight regain. Evidence supports moderate-intensity PA between 150 and 250 min wk(-1) to be effective to prevent weight gain. Moderate-intensity PA between 150 and 250 min wk(-1) will provide only modest weight loss. Greater amounts of PA (>250 min wk(-1)) have been associated with clinically significant weight loss. Moderate-intensity PA between 150 and 250 min wk(-1) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction. Cross-sectional and prospective studies indicate that after weight loss, weight maintenance is improved with PA >250 min wk(-1). However, no evidence from well-designed randomized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss. Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk. Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk. There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain.

Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults

2013 AHA/ACC/TOS Guideline for the Management of Overweight

Loria, Barbara E. Millen, Cathy A. Nonas, F. Xavier Pi-Sunyer, June Stevens, Victor J. Stevens, Karen A. Donato, Frank B. Hu, Van S. Hubbard, John M. Jakicic, Robert F. Kushner, Catherine M. Michael D. Jensen, Donna H. Ryan, Caroline M. Apovian, Jamy D. Ard, Anthony G. Comuzzie, Practice Guidelines and The Obesity Society Report of the American College of Cardiology/American Heart Association Task Force on 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2013 American Heart Association, Inc. All rights reserved. is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Circulation published online November 12, 2013; Circulation. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee.citation World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circ.ahajournals.org/content/suppl/2013/11/07/01.cir.0000437739.71477.ee.DC1.html Data Supplement (unedited) at:

/pdf/2013-aha-acc-tos-guideline-for-the-management-of-overweight-3w1saiwrmy.pdf

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

https://care.diabetesjournals.org/content/diacare/33/12/2692.full.pdf

Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement.

ContextA higher duration and intensity of exercise may improve long-term weight
loss.ObjectiveTo compare the effects of different durations and intensities of exercise
on 12-month weight loss and cardiorespiratory fitness.Design, Setting, and ParticipantsRandomized trial conducted from January 2000 through December 2001 involving
201 sedentary women (mean [SD] age, 37.0 [5.7] years; mean [SD] body mass
index, 32.6 [4.2]) in a university-based weight control program.InterventionParticipants were randomly assigned to 1 of 4 exercise groups (vigorous
intensity/high duration; moderate intensity/high duration; moderate intensity/moderate
duration; or vigorous intensity/moderate duration) based on estimated energy
expenditure (1000 kcal/wk vs 2000 kcal/wk) and exercise intensity (moderate
vs vigorous). All women were instructed to reduce intake of energy to between
1200 and 1500 kcal/d and dietary fat to between 20% and 30% of total energy
intake.Main Outcome MeasuresBody weight, cardiorespiratory fitness, and exercise participation.ResultsAfter exclusions, 184 of 196 randomized participants completed 12 months
of treatment (94%). In intention-to-treat analysis, mean (SD) weight loss
following 12 months of treatment was statistically significant (P <.001) in all exercise groups (vigorous intensity/high duration
= 8.9 [7.3] kg; moderate intensity/high duration = 8.2 [7.6] kg; moderate
intensity/moderate duration = 6.3 [5.6] kg; vigorous intensity/moderate duration
= 7.0 [6.4] kg), with no significant difference between groups. Mean (SD)
cardiorespiratory fitness levels also increased significantly (P = .04) in all groups (vigorous intensity/high duration = 22.0% [19.9%];
moderate intensity/high duration = 14.9% [18.6%]; moderate intensity/moderate
duration = 13.5% [16.9%]; vigorous intensity/moderate duration = 18.9% [16.9%]),
with no difference between groups. Post hoc analysis revealed that percentage
weight loss at 12 months was associated with the level of physical activity
performed at 6 and 12 months. Women reporting less than 150 min/wk had a mean
(SD) weight loss of 4.7% [6.0%]; inconsistent (other) pattern of physical
activity, 7.0% [6.9%]; 150 min/wk or more, 9.5% [7.9%]; and 200 min/wk or
more of exercise, 13.6% [7.8%].ConclusionsSignificant weight loss and improved cardiorespiratory fitness were
achieved through the combination of exercise and diet during 12 months, although
no differences were found based on different exercise durations and intensities
in this group of sedentary, overweight women.

https://jamanetwork.com/journals/jama/articlepdf/197256/JOC30009.pdf

Effect of exercise duration and intensity on weight loss in overweight, sedentary women: A Randomized trial

JAKICIC, J. M., M. MARCUS, K. I. GALLAGHER, C. RANDALL, E. THOMAS, F. L. GOSS, and R. J. ROBERTSON. Evaluation of the SenseWear Pro Armband™ to Assess Energy Expenditure during Exercise. Med. Sci. Sports Exerc., Vol. 36, No. 5, pp. 897–904, 2004.Purpose:To assess the accuracy of the SenseWea

Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise.

LAGALLY, K. M., R. J. ROBERTSON, K. I. GALLAGHER, F. L. GOSS, J. M. JAKICIC, S. LEPHART, and B. GOODPASTER. Perceived exertion, electromyography, and blood lactate during acute bouts of resistance exercise. Med. Sci. Sports Exerc., Vol. 34, No. 3, pp. 552–559, 2002.PurposeThis study examined ratings

Perceived exertion, electromyography, and blood lactate during acute bouts of resistance exercise.

ContextA higher duration and intensity of exercise may improve long-term weight
lossObjectiveTo compare the effects of different durations and intensities of exercise
on 12-month weight loss and cardiorespiratory fitnessDesign, Setting, and ParticipantsRandomized trial conducted from January 2000 through December 2001 involving
201 sedentary women (mean [SD] age, 370 [57] years; mean [SD] body mass
index, 326 [42]) in a university-based weight control programInterventionParticipants were randomly assigned to 1 of 4 exercise groups (vigorous
intensity/high duration; moderate intensity/high duration; moderate intensity/moderate
duration; or vigorous intensity/moderate duration) based on estimated energy
expenditure (1000 kcal/wk vs 2000 kcal/wk) and exercise intensity (moderate
vs vigorous) All women were instructed to reduce intake of energy to between
1200 and 1500 kcal/d and dietary fat to between 20% and 30% of total energy
intakeMain Outcome MeasuresBody weight, cardiorespiratory fitness, and exercise participationResultsAfter exclusions, 184 of 196 randomized participants completed 12 months
of treatment (94%) In intention-to-treat analysis, mean (SD) weight loss
following 12 months of treatment was statistically significant (P <001) in all exercise groups (vigorous intensity/high duration
= 89 [73] kg; moderate intensity/high duration = 82 [76] kg; moderate
intensity/moderate duration = 63 [56] kg; vigorous intensity/moderate duration
= 70 [64] kg), with no significant difference between groups Mean (SD)
cardiorespiratory fitness levels also increased significantly (P = 04) in all groups (vigorous intensity/high duration = 220% [199%];
moderate intensity/high duration = 149% [186%]; moderate intensity/moderate
duration = 135% [169%]; vigorous intensity/moderate duration = 189% [169%]),
with no difference between groups Post hoc analysis revealed that percentage
weight loss at 12 months was associated with the level of physical activity
performed at 6 and 12 months Women reporting less than 150 min/wk had a mean
(SD) weight loss of 47% [60%]; inconsistent (other) pattern of physical
activity, 70% [69%]; 150 min/wk or more, 95% [79%]; and 200 min/wk or
more of exercise, 136% [78%]ConclusionsSignificant weight loss and improved cardiorespiratory fitness were
achieved through the combination of exercise and diet during 12 months, although
no differences were found based on different exercise durations and intensities
in this group of sedentary, overweight women

Effect of exercise duration and intensity on weight loss in overweight, sedentary women. a randomized trial

To test the hypothesis that longer and more intense exercise will enhance long-term weight loss, 201 sedentary women 27 to 40 years of age were enrolled in a randomized trial. The participants, whose baseline body mass index ranged from 27 to 40 kg/m 2 , were in a university-based weight control program. They were assigned to 1 of 4 groups that exercised at moderate or vigorous intensity for a moderate to long duration. Estimated energy expenditure was 1000 or 2000 kcal per week. All women were asked to reduce their energy intake to 1200 to 1500 kcal per day and their dietary fat intake to 20% to 30% of total energy intake. Nearly 95% of participants completed 12 months in the study. All participants were sedentary at the outset, exercising less than 3 days per week for less than 20 minutes. They were instructed to exercise, unsupervised, for 5 days a week, primarily by walking; motorized treadmills were provided. Bouts of exercise lasting at least 10 minutes were prescribed in terms of both percentage of age-predicted maximal heart rate and perceived exertion using the Borg scale. The women attended an average of 79% of group sessions in the first 6 months and 71% over the entire 12-month study period. Mean weight loss was significant in all groups, ranging from 8.9 kg with long-lasting vigorous exercise to 6.3 kg with moderate exercise of moderate duration. There were no significant between-group differences. Mean cardiorespiratory fitness also increased significantly in all groups, most markedly (22%) with vigorous, high-duration exercise. The least improvement, an increase of 13.5%, was in the group exercising at moderate intensity for a moderate time. Again, there were no differences between groups. Weight loss at 12 months correlated with the level of physical activity at both 6 and 12 months. Women exercising less than 150 minutes per week lost a mean of 4.7% body weight, contrasting with 13.6% for those exercising at least 200 minutes per week. There were no significant group differences in energy intake. The authors recommend that sedentary adults who are overweight begin by exercising at moderate intensity for at least 150 minutes per week. When appropriate, higher exercise levels should be adopted, aiming at an hour a day as advised by the Institute of Medicine.

Kara I. Gallagher

Papers

Effect of exercise duration and intensity on weight loss in overweight, sedentary women: A Randomized trial

Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise.

Perceived exertion, electromyography, and blood lactate during acute bouts of resistance exercise.

Effect of exercise duration and intensity on weight loss in overweight, sedentary women. a randomized trial

Effect of Exercise Duration and Intensity on Weight Loss in Overweight, Sedentary Women: A Randomized Trial