Obesity represents a significant public health concern with one-third of adults classified as living with obesity in the United States and correlates with cardio-metabolic comorbidities that can decrease the quality of life. Researchers have proposed that exercise can be a vital sign in the healthcare setting, and this may be especially important in the context of obesity. This review will cover the role of exercise in obesity and fitness.
The definition of obesity is excessive fat accumulation in adipose tissues, to the extent that health is impaired and defined by having a body mass index (BMI) greater than or equal to 30 kg/m. Obesity correlates with increasing an individual’s risk of cancers, stroke, metabolic disease, heart failure, and other cardiovascular conditions , highlighting the need to reduce incidence and prevalence of obesity. Chronic low-grade inflammation associated with obesity is hypothesized to have associations with the adverse cardio-metabolic side effects. Although short term inflammation is beneficial to initiate an immune response, chronically elevated levels of inflammation exhaust the immune system and contribute to immune dysfunction. Researchers posit that this inflammation is stimulated by the excess adipose tissue, which has consistently shown to play a role as an active endocrine organ.
Reducing adipose tissue is a means of reducing weight in individuals with obesity, and is necessary to mitigate negative cardio-metabolic co-morbidities in obesity. Two methods exist that can effectively decrease adipose tissue and include: 1. dietary modification, and 2. energy expenditure modification (i.e., exercise). Thus, increasing energy expenditure can help reduce excess adipose tissue and obesity. The current guidelines put out by the American College of Sports Medicine (ACSM) include either aerobic or anaerobic exercise. Aerobic exercise (i.e., running, cycling, rowing, etc.) is an exercise that exhausts the oxygen in the muscles, but oxygen consumption is sufficient to supply the energy demands placed on the muscles and does not need to derive energy from another source. On the other hand, anaerobic exercise (or resistance exercise, i.e., weight lifting) is oxygen consumption that is not sufficient to supply the energy demands placed on the muscles, and your muscles must break down other energy supplies, such as sugars, to produce energy and lactic acid. Physical activity (PA), is included in the exercise, although it does not necessarily include structured exercise plans/sessions.
The measurement of exercise is conducted in “metabolic equivalent tasks” (METs), which roughly equate to the effort and energy expenditure it takes for an individual to sit quietly. Physical activity is frequently incorporated into different lifestyle interventions, highlighting the need for regular amounts of physical activity throughout the day. Physical activity in the general lifestyle includes goal-setting, problem-solving, leisure-time physical activity, and activity used for commuting. Outcomes of interest include cardiorespiratory fitness, body composition, and muscular fitness. Recently, much literature has shown the positive effects of exercise on not only physical measures but also cognitive and emotional measures in people of all ages.
Individuals living with obesity can partake in the same exercise prescriptions as individuals who are living at a normal weight. However, special considerations must be made, such as current co-morbidities that may be associated with obesity like orthopedic risk (i.e., arthritis), pulmonary, and/or cardiac co-morbidities. However, this should not deter individuals away from participating in exercise programs, as exercise is extremely important for overall health. Currently, there are several exercise guidelines for individuals living with obesity and include the American College of Sports Medicine (ACSM), the Obesity Medical Association (OMA), and the Obesity Society (TOS), which are all clinically available to aid individuals in prescribing exercise. Here, we outline the general recommendations for individuals living with obesity and exercise.
The overarching goal in individuals living with obesity and exercise includes reducing excess fat mass, increasing muscle mass, and increasing overall PA. Therefore, the following guidelines for individuals with obesity to exercise are summarized as follows:
Utilizing exercise as a means of reducing obesity (i.e., reducing fat mass) has benefits beyond the reduction of fat mass. Fitness is associated with more desirable clinical outcomes in many instances, such as decreasing metabolic disease , cardiovascular disease , Alzheimer disease risk , inflammation , and many other disease states not listed here. If the patient is able to exercise, exercise may be the preferred route to decrease disease symptoms and/or future risk compared to alternative pharmaceuticals that may exacerbate symptoms. An open and communicative relationship between the physician, healthcare team, and the patient must be present in order to suggest the addition of exercise to the patient's lifestyle in order to decrease obesity and improve negative side effects. 
The healthcare team (nurse practitioner, primary care provider, internist, endocrinologist, bariatric surgeon, pharmacist, and obesity nurse) should implement many strategies to increase physical activity and fitness for individuals living with obesity and includes utilizing “exercise vital signs,” tracking exercise, motivational interviewing, and periodic check-ins. Currently, the following could potentially be implemented into practice to encourage patients living with obesity to exercise:
Exercise/physical activity is a proven modality for treating the disease of overweight and obesity. Individuals living with obesity can certainly exercise and increase their fitness in the same way. However, management of this disease is best through dietary interventions and regular exercise. Exercise is an integral part of not only weight loss, but overall health as well. Individuals living with obesity can increase exercise in their daily lives with the help of their medical team to increase exercise and PA in their daily routine.
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