Most people are surprised to learn that there is no evidence that exercise causes weight loss. It is probably the single best thing that you can do to a human body to create or maintain health, but its role in weight loss is very secondary.
By and large, people who exercise weigh less on average than people who don’t exercise. However, that’s correlation – not causation. Exercise helps prevent excess weight gain, which is the key. People who exercise regularly tend to gain weight slower (or not at all) compared to people who don’t exercise.
For many people, exercise is their anchor to health. When they exercise, they eat better, and eating better improves their weight.
For some patients, exercise is incredibly daunting, and being asked to do some type of exercise is enough to cause them to walk away, which is not what we want. For some patients, exercise puts them at risk of falls or exacerbating other physical ailments and needs to be approached very cautiously.
Exercise is a huge part of weight maintenance and introducing the concept as they are getting close to maintenance is our responsibility. Most people will have already gone there. People who are losing weight, lowering inflammation, feeling good about themselves, and getting healthier almost always spontaneously start some type of exercise program.
Most patients, at some point, are going to ask for some guidance regarding exercise. We have lots of handouts you can give them but as to the actual “how to do it”, that needs to be up to them, hopefully with the help of a helpful, qualified personal trainer or exercise physiologist.
Here are a few things that I say to patients over and over again regarding exercise:
- Exercise isn’t going to move the needle on the scale or give them a cushion for frequent indulgences, but they should absolutely do it. It’s like brushing teeth – necessary, but not weight-negative
- If someone hasn’t been an exerciser before starting the program, I tell them not to start right away. Exercise has been shown to cause an increase in hunger during the first 6 weeks, which makes it harder to stick to a new eating plan. After 6 weeks that hunger dissipates and is actually replaced by increased satiation (meaning they feel full sooner during a meal)
- If they were exercisers before losing weight, during the initial phase of weight loss, they may find that their exercise tolerance decreases – they feel more worn out or have to decrease their weights or lower their intensity. This isn’t bad – it’s expected and will resolve
- I never recommend a pre-workout or post-workout drink or bar of any kind during active weight loss Most people (on the advice of trainers) carb load or do some type of pre-workout drink that floods the bloodstream with glucose, which is easy for the body to burn during exercise. This is great when trying to build muscle during exercise. However, when losing weight, we are asking the body to grab energy from the fat stores, which is more difficult. It’s not bad – just different.
- Furthermore, after exercise, the muscle insulin receptors are wide open – which is huge for reversing insulin resistance. Having something sugary or carby or fake-sugary (all of which raise insulin) will clamp those insulin receptors closed
- Strength training is the best exercise to do during active weight loss as it helps prevent loss of lean body mass. Many people are highly focused on cardio as they are stuck in the calorie balance idea and we’ve all been taught that cardiovascular exercise causes the greatest calorie burn, but as it turns out, it’s just not that simple.
- Those little machines that calculate your calorie deficit are incredibly inaccurate and not worth looking at
- Exercise doesn’t need to be extreme to cause health improvements. 20 minutes every day is enough to see progress over the long term. Some is better than none.
Three Primary Components of Exercise
To maximize the benefits of physical activity, clinicians should guide patients in addressing three main areas of exercise: cardiovascular endurance, strength, and stability.
1. Cardiovascular Endurance and Efficiency
Engaging in regular cardiovascular exercise helps patients improve their ability to utilize both glucose and fat for fuel, increasing metabolic flexibility. This type of exercise supports mitochondrial health by stimulating the creation of new mitochondria and eliminating dysfunctional ones.
Zone 2 Training: Training in the aerobic “Zone 2” range supports the development of type I muscle fibers, enhancing the body’s ability to use fat as fuel and improving insulin sensitivity.
Immediate Impact on Blood Glucose: Even five minutes of brisk walking can help to significantly lower blood glucose levels. This non-insulin-mediated glucose uptake allows glucose to cross cell membranes without insulin, bypassing muscle insulin resistance and lowering blood sugar.
2. Strength
Strength training is critical for preventing muscle loss, especially during weight loss. Retaining muscle mass helps mitigate the decrease in resting metabolic rate (RMR) often seen with weight reduction. This also supports overall physical resilience.
Building Muscle and Mitigating Sarcopenia: Muscle strength declines at a faster rate than muscle mass, leading to issues like fatigue, weakness, and increased fall risk. To mitigate these risks, strength training should be incorporated at least two times per week, focusing on major muscle groups.
Eccentric Strength: Strengthening muscles during their lengthening phase, or eccentric contraction, supports joint health. Patients with reduced eccentric strength are at a higher risk for joint injuries and increased stress on connective tissues.
3. Stability
Strength alone does not ensure stability. Stability training involves exercises that support coordination and core strength, which protect the joints and spine during movement.
Importance of Core Stability: A stable core protects the spine, reduces the risk of falls, and supports overall physical function. Stability training helps patients react to internal and external stimuli, allowing their muscles to adjust without conscious effort.
Functional Benefits: Stability-focused exercises can improve balance, postural control, and the body’s ability to harness and decelerate forces, reducing the strain on joints and soft tissues.
Non-Exercise Activity Thermogenesis (NEAT)
NEAT represents the energy utilized during non-structured activities, such as standing, walking around, and performing daily tasks. It is distinct from formal exercise and contributes significantly to total daily energy expenditure. Encouraging patients to increase NEAT can help them boost their metabolism and improve cardiovascular health without the need for formal exercise sessions.
Simple Strategies for Increasing NEAT:
- Use a stability ball instead of a chair.
- Walk during phone calls or use stairs instead of the elevator.
- Perform light housework or stretching during television breaks.
- Park farther away from entrances and walk where possible.
These small adjustments can help patients incorporate more movement into their daily routines, especially if formal exercise is daunting.
Guiding Patients in Exercise Initiation:
Many patients are intimidated by the idea of starting an exercise routine. As healthcare providers, it’s essential to provide a welcoming approach, assessing each patient’s readiness and tailoring recommendations to their current fitness level. Some considerations include:
Assessing Barriers and Readiness:
Begin by discussing patients’ exercise history, potential injuries, and current lifestyle barriers, such as time constraints or financial limitations.
Modifying Exercises for Safety:
Certain patients may need modifications, especially those with existing health issues or physical limitations. For example, walking at a slower pace can reduce joint impact for patients with knee osteoarthritis, while water-based exercises may be beneficial for those with limited mobility.
Movement plays a crucial role in obesity treatment, extending beyond weight management to improve metabolic health, prevent chronic diseases, and support long-term physical resilience. By incorporating movement in a way that addresses cardiovascular fitness, strength, stability, and everyday activities, clinicians can help their patients establish a sustainable, enjoyable routine that promotes overall health.