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

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

/pdf/exercise-as-medicine-evidence-for-prescribing-exercise-as-4ap89k53ch.pdf

Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

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

ContextPhysical inactivity contributes to weight gain, but
only 22% of Americans are regularly active.ObjectiveTo examine short- and long-term changes in weight, body
composition, and cardiovascular risk profiles produced by diet combined
with either structured aerobic exercise or moderate-intensity lifestyle
activity.DesignSixteen-week randomized controlled trial with 1-year
follow-up, conducted from August 1995 to December 1996.Participants and SettingForty obese women (mean body mass index
[weight in kilograms divided by the square of height in meters], 32.9
kg/m2; mean weight, 89.2 kg) with a mean age of 42.9 years
(range, 21-60 years) seen in a university-based weight management
program.InterventionsStructured aerobic exercise or moderate lifestyle
activity; low-fat diet of about 1200 kcal/d.Main Outcome MeasuresChanges in body weight, body composition,
cardiovascular risk profiles, and physical fitness at 16 weeks and at 1
year.ResultsMean (SD) weight losses during the 16-week treatment
program were 8.3 (3.8) kg for the aerobic group and 7.9 (4.2) kg for
the lifestyle group (within groups, P<.001; between groups,
P = .08). The aerobic group lost significantly less fat-free
mass (0.5 [1.3] kg) than the lifestyle group (1.4 [1.3] kg;
P = .03). During the 1-year follow-up, the aerobic group
regained 1.6 [5.5] kg, while the lifestyle group regained 0.08 (4.6)
kg. At week 16, serum triglyceride levels and total cholesterol levels
were reduced significantly (P<.001) from baseline (16.3%
and 10.1% reductions, respectively) but did not differ significantly
between groups and were not different from baseline or between groups
at week 68.ConclusionsA program of diet plus lifestyle activity may
offer similar health benefits and be a suitable alternative to diet
plus structured aerobic activity for obese women.

https://jamanetwork.com/journals/jama/articlepdf/188404/JOC80705.pdf

Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial.

OBESITY IS A SERIOUS AND common health problem The most recent National Health and Nutrition Examination Survey (NHANES III) reported that 334% of Americans are overweight, representing an increase from the 25% prevalence observed in the 1976-1980 survey Although it is commonly believed that easy access to high-fat foods and overeating are the simple causes of obesity, mean energy intake and fat consumption in industrialized countries have declined substantially as obesity rates have escalated During this time, levels of physical activity have steadily declined and a report by the surgeon general indicates that only 22% of US adults are currently active enough to derive the health benefits conferred by physical activity These findings have prompted public health advisors to recommend that all Americans strive to accumulate 30 minutes or more of moderate-intensity physical activity on most, or preferably all, days of the week Blair and colleagues have described a lifestyle approach to physical activity; in which sedentary adults incorporate short bouts of moderate-intensity activity into their daily routines, such as increasing the amount of walking in the daily routine, performing more yard work, and using the stairs when possible The purpose of this investigation was to examine shortand long-term changes in weight, body composition, and cardiovascular risk profiles produced by diet Author Affiliations: Division of Geriatric Medicine and Gerontology (Dr Andersen and Mr Franckowiak) and Department of Medicine (Dr Bartlett), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia (Dr Wadden); Children’s Hospital of Philadelphia (Dr Zemel); and Department of Sports Science, Cabrini College, Radnor, Pa (Dr Verde) Corresponding Author and Reprints: Ross E Andersen, PhD, Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, 5501 Hopkins Bayview Cir, JHAAC 5B:81, Baltimore, MD 21224 (e-mail: andersen@jhmiedu) Context Physical inactivity contributes to weight gain, but only 22% of Americans are regularly active

Effects of Lifestyle Activity vs Structured Aerobic Exercise in Obese Women

PURPOSE The purposes of this study were two-fold: (1) to evaluate the effects of an 8-wk weight loss program on natural killer (NK) cell activity in obese women and 2) to determine whether an additional program of combined aerobic and resistance exercise training modified the effects of caloric restriction on immune function. METHODS Twenty-two healthy obese women with a mean weight of 96.9 +/- 14 kg and age of 38 +/- 7 yr were randomly assigned to diet-alone (D) or diet-plus-exercise training (D + EX) conditions. Subjects consumed 950 kcal.d-1 using prepackaged portion-controlled foods. Subjects in the D + EX group participated 3 times.wk-1 in a supervised program of light-to moderate-intensity aerobic activity and resistance training. Data were analyzed using a repeated measures ANOVA. RESULTS After 8 wk of treatment, body weight decreased significantly in both groups (10.8% in D vs 11.4% in D + EX), whereas absolute and relative VO2peak increased in only D + EX (12.3% in D vs 57.7% in D + EX). Both groups experienced significant decreases in peripheral blood leukocytes and lymphocytes, although cell numbers remained within clinically normal range at week 8. NK cell (CD56+) proportion was unchanged in both groups after weight loss. The proportion of peripheral mononuclear cells expressing the interleukin-2 receptor-alpha (IL-2R alpha) (CD25+) decreased significantly (25.2%) in D and was unchanged in D + EX, resulting in a significant difference between groups at week 8. NK cell cytotoxicity was suppressed in D and unchanged in D + EX after treatment. Changes in NK cell activity were significantly correlated with proportional changes in (CD25+) (r = 0.584, P = 0.022), but not CD56+. CONCLUSIONS A combined program of light- to moderate-intensity aerobic and resistance exercise offsets the apparent decrement in NK cell activity associated with weight loss.

T. J. Verde

Papers

Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial.

Effects of Lifestyle Activity vs Structured Aerobic Exercise in Obese Women

Effects of weight loss and exercise training on natural killer cell activity in obese women.

Lifestyle or aerobic exercise to treat obesity in dieting women 266

The use of a three dimensional (bio-trainer???) accelerometer to measure graded walking in obese women 258