• Obesity was considered as a risk factor for CV, but now there is a paradigm shift and is viewed now as a disease.
• Fat mass is measured nowadays for obesity and overweight rather than BMI.
• Countries that were more active had less obesity. (Steps per day)

Definition of Obesity

Exercise training in obesity

• Exercise program to be chosen depending on the goal of the patient.
• The thicker the line (In the diamond) means more study were performed.
  
• AET is statistically significant to decrease body weight by 2kg (Is it enough??)
• Resistance training can be complementary to increase fat free mass.

After bariatric surgery

• Exercise should be integrated post-op.
• It is important to also maintain and increase muscle mass.
• Improvements in VO2peak 2,87 (95%CI 0,63-5,12)ml/min/kg
• Behavioural change program should be integrated to maintain (maintenance) PA on a long run.

Intake + different types of exercise

• Nutritionist should be part of the rehab team.
• Fat free mass could decrease when energy (food) is restricted, therefore PA should be integrated to avoid losing Fat free mass
• They require motivation as mostly obese patients are genetically obese, and their lifestyle is not dependent on moving.
  
• When a patient has 2 RIR, weight could be progressed in the following session.

Recommendations for exercise programs

• Special attention
  • Preferably low impact activities / non weight bearing exercise
  • Overuse Injury prevention
  • Risk of hyperthermia
  • Equipment may need modification (wide seats, check weight capacity of equipment!)
  • Strength training may serve as a valuable adjunct in order to gain FFM
  • Goal setting in the context of behavioral interventions (prioritization)
  • In case of medication (e.g. Ozempic / insuline) check glycemia
    
    
• Begin with low impact activities to decrease overlad and overuse injuries.
  • Perhaps recommend a sport shoes for walking/training.
  • Include rest per set, and implement stretching pre/post workout
• Risk of hyperthermia
  • Fat tissue prevent excreating heat.
  • Sign is when a patient turns reddish
  • Alert them to be hydrated when performing there home program
• Equipment may need modification (wide seats, check weight capacity of equipment!)
• Strength training may serve as a valuable adjunct in order to gain FFM
• Goal setting in the context of behavioral interventions (prioritization)
• In case of medication (e.g. Ozempic / insuline) check glycemia
  • Perhaps it could be recommended to have a glycometer in practice.

Obese Children

• It is outside the scope of this lecture but attention should be given to underweight children.
  
• Z-score in literature is studied in this population because children grow and measuring kg decrease wont be efficient
  
• Obese boys are active in the weekdays during morning-noon time, but are not later in the day.
  
  
• Exer-gaming a promissing new trend; it should have enough oxygen consumption.