- 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.
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