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Lifestyle Management of Adult Obesity

Exercise Plan


Exertion (RPE) of 12-14 was prescribed. An initial duration of aerobic exercise of 20-30 minutes including warm-up and cool-down was recommended.

After discussion relative to precautions about her history of knee osteoarthritis pain, she selected treadmill walking and an air-braked arm and leg ergometer for aerobic exercise. A distribution of 67% of time on the treadmill and 33% on the ergometer was recommended. She was instructed to progress in duration at a rate of 10% to 20% per week.

In addition, Mrs. Jones was instructed to apply heat in the form of an OTC topical ointment with Capsaicin at 0.075% prior to and an ice pack followed by mild stretching for ten (10) minutes post-exercise to both knees.

The standard Sit and Reach Test suggested fair overall flexibility, but other than knee pain there were no additional musculoskeletal deficiencies or complaints; therefore she was instructed in a general flexibility program.

Recent studies suggest complimentary health and weight loss benefits (i.e., preservation of or increased lean body mass, increased muscle strength, and possibly increased resting metabolism) can be achieved through a progressive resistance training program. [60] Hence, she was instructed in a moderate intensity (~50% to 70% of one repetition maximum at an RPE of 12-14 or somewhat heavy) circuit weight training program consisting of 8-10 multi-joint upper and lower body exercises performed for 1-2 sets, 10-15 repetitions each, with initially a rest period of 60 seconds and a goal of 15-30 seconds rest period between sets.

Due to potential time restrictions, the recommendation was to do this 2-3 days per week. Total caloric expenditure seems more predictive of both weight loss and maintenance of weight loss. [76] Therefore, recommendations concerning lowering intensity of exercise (perhaps more tolerable for her with respect to both her obesity and complaints of knee pain) and increasing duration were emphasized.

In addition, studies show that “lifestyle exercise” (increasing physical activity in daily life) can result in similar weight loss and health benefits as structured exercise. [61] [62] She was asked to wear a pedometer for seven days to assess her usual level of physical activity (PA). The results showed that she accumulated only about 3,000 steps per day. Based on these findings, she was also encouraged to purchase a pedometer and to increase daily physical activity by taking more walks, climbing stairs more often, and engaging in active recreational pursuits of her choice such as gardening.

Mrs. Jones also indicated she enjoyed nature and was encouraged to take a 30-60 minute recreational hike, 1-2 days per week. She watched about ten hours of television per week. She was asked to reduce her time watching television and to walk around the house and climb stairs during commercials. A goal of increasing her daily physical activity to 6,000-10,000 steps per day was established.

Even if she had some return of weight gain, continuing to exercise would maintain benefits in LDL and HDL cholesterol, oxygen consumption, blood pressure, and glucose. [80]

Finally, she was advised about precautions with exercise particularly those related to signs of exercise intolerance and coronary ischemia. The facility at her worksite is staffed 13 hours per week by clinical exercise physiologists, and she was advised to use the facility at least twice per week under their supervision.


Pertinent information

Use of combined modalities to decrease weight-bearing time; addition of resistance training; addition of reinforcement for lifestyle exercise.

Consider

Use of supervised program and group exercise for motivational purposes; regular feedback and contact to reinforce consistent, regular exercise; consult with exercise professional to assist with progression of exercise program.



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Last Update: March 6 2013