Exercise & Physical Activity: How Much is Enough? Heather Mackie, MS, RD, LD Sponsored by:

Exercise & Physical Activity (PA) There is a difference between being physically active throughout your day and making sure you exercise on a regular basis Exercise: structured, planned type of PA PA: any movement of body that requires energy Both are equally important As a weight loss surgery (WLS) patient you can ensure success by incorporating both Ask for examples of PA and exercise from group Some examples PA: taking stairs instead of elevator, parking further away, etc. Exercise: walking, running, strength training, zumba, cycling, spin classes, etc.

Benefits of Exercise Increases muscle & bone strength Increases lean muscle & decreases body fat Aids in weight maintenance & weight loss Improves psychological well-being Can reduce symptoms of depression and anxiety, as well as, improve mood Adapted from Healthy People 2010, CDC CDC = Centers for Disease Control & Prevention

Exercise is… Relative Individual Different goals Meaning that what one person does to exercise, another person might see as impossible Individual Meaning you should do what you can do at this point in time You should incorporate things you enjoy Different goals You will most likely have different goals than the person sitting next to you One person might run to do their exercise, whereas, a person in a wheelchair obviously would not be able to do that. But maybe the person in the wheelchair could work to stand up and down in the wheelchair as exercise

Two Types of Exercise Aerobic/Cardiovascular or “Cardio” Ex: walk, jog, swim, bike, zumba Causes you to breathe harder & faster while increasing heart rate Performed on a regular basis, it will improve the health of your lungs, heart, and blood vessels Improves fitness of heart Increases stamina & performance Strengthens heart to pump blood more efficiently Increases lung capacity Helps increase metabolism The first type of exercise we are going to discuss today is cardio

Two Types of Exercise Resistance/Strength Training Ex: free weights, machines, exercise bands, using your own body weight Increases lean body mass (muscle on your frame) Building muscle improves: Range of motion Improves metabolism Increases strength Improves balance Improves mobility The other type we are going to discuss today is resistance or strength-training

Muscle & Metabolism Muscle is an active tissue Meaning muscle is always working It is always burning calories This contributes to the calories burned from RMR Strength training adds muscle Which will burn more calories Muscle uses fat for energy RMR = resting metabolic rate

Exercise is the gift that… Keeps on giving! After your exercise session, your metabolism is higher for up to 24 hrs increasing the total number of calories you burn per day Some call this the “after burn” of exercise This is why it helps to lose weight by exercising frequently throughout the week to burn more calories throughout the day

Exercise Triple-Play Three ways to burn calories with exercise: Burn calories while exercising The “after-burn” of exercise The calories you burn with your metabolism being elevated up to 24 hrs after exercising Exercise adds muscle which burns more calories Muscle helps to increase your metabolic rate when you are resting AND when you exercise

Combining Cardio & Strength-Training Helps to lose weight effectively & efficiently Increases metabolism Changes the shape of your body Helps you to get healthy & stay healthy

Weight Loss vs. Weight Maintenance Exercise is not required to achieve weight loss However, you do need a calorie deficit Exercise is a great way to create that calorie deficit Exercise is essential for weight maintenance So we have discussed that exercise will help maintain wt loss and once you lose weight it is probably the only way you will maintain the loss But how much exercise? Most people will agree that low-intensity, long duration exercise is equivalent to high-intensity, short duration exercise The most important thing is to expend calories If you are overweight, not currently active, then moderate-intensity is the best choice b/c it can be done for longer durations for each session and can be done daily Obviously it is important to talk with your physician before starting an exercise program

Surgeon General’s Call to Exercise & Physical Activity 5 times per week of cardio for 30 minutes at moderate intensity OR 3 times per week of cardio for 20 minutes at vigorous intensity PLUS 2 times per week of strength training exercising all major muscles in body Pick a choice for cardio and then add in strength/resistance training 2001

Surgeon General’s Call to Exercise & Physical Activity Adults should do 150 minutes of moderate-intensity physical activity per week. Spread aerobic activity (brisk walking or general gardening) into 10 minute episodes throughout the week The changes for 2010 were rather than look at what people do daily, was to try and spread it out throughout the week so as to increase the after-burn of exercise and increase total calories burned 2010

Many Confusing Recommendations CDC/ACSM: All adults should do at least 30 minutes of moderate- intensity physical activity on most, preferably all, days of the week IOM: One hour per day of moderate-intensity physical activity to help maintain weight in the normal BMI range, and for full health benefits CDC = Center for Disease Control & Prevention ACSM = American College of Sports Medicine IOM = Institute of Medicine The 30-minute recommendation is viewed as a “minimum” physical activity recommendation for achieving health outcomes Additional exercise, including vigorous exercise, provides additional health and fitness benefits

What is Moderate Intensity? 3-6 Metabolic Equivalents (METs) of physical activity: 3.0 = Canoeing, rowing, light effort 3.0 = Walking, 2.5 mph, firm surface 4.0 = Swimming, treading water, moderate effort 4.5 = Basketball, shooting baskets 5.0 = Kayaking 6.0 = Downhill skiing, moderate effort Sometimes when you are on a cardio machine it will measure your METs Both recommendations say “moderate intensity,” but does the average person know what moderate intensity is?

Confusing Recommendations At moderate intensities, free fatty acids are mobilized from the periphery to provide the majority of fuel used and to help with maintaining fat balance Fat-burning is not restricted to low-intensity activity Fat and calories are also used during high-intensity exercise Training programs using intermittent high-intensity exercise are most beneficial (interval training)

National Weight Control Registry Formed in 1993 to learn what made “successful losers” Successful losers = lost a minimum of 30 pounds and kept it off for at least one year

Key Strategies of Successful Losers Engaging in high-level physical activity Eating a diet low in calories and fat Eating breakfast Self-monitoring weight on a regular basis Maintaining a consistent eating pattern Catching slips before they result in larger weight gains PA=burned ~ 400 calories per day Fat < 25% of total calories Self-Monitor by weighing regularly (once/week) Consistent eating pattern: for example didn’t do extremely restrictive diet patterns and were consistent over time Get back on track as soon as they fall off

Pedometer Recommendations ACSM: Active PA level is to take at least 10,000 steps per day Benefits of using a pedometer Easy to use Relatively inexpensive Negatives of using a pedometer Don’t measure intensity or heart rate May not calculate steps correctly May not stay on waistband

2005 Dietary Guidelines 30 minutes of PA to reduce risk of chronic disease 60 minutes of moderate to vigorous PA sometimes needed to prevent gradual weight gain that occurs over time 60-90 minutes of moderate-intensity PA to sustain weight loss Those who need to lose weight: Aim for a slow, steady weight loss by decreasing calorie intake, while maintaining an adequate nutrient intake and increasing physical activity Overweight adults and overweight children with chronic diseases and/or on medication: Consult a health care provider about weight-loss strategies prior to starting a weight-reduction program to ensure appropriate management of other health conditions

2010 Dietary Guidelines Same recommendations but add: Increase physical activity & reduce time spent in sedentary behaviors

New Recommendations Position Stand from the ACSM An initial goal of 150 minutes/week of moderate physical activity Progressing to 200-300 minutes/week Consistent with the observations from the study of successful losers and original recommendations from the CDC/ACSM and IOM

The Bottom Line Translating science into practice is not easy Recommendations are confusing for the majority of adults BOTTOM LINE: Any amount of exercise and physical activity is beneficial, but clearly the more the better JUST DO IT!

Your Mission: For Pre-Op Patients Get as healthy as possible before surgery by implementing healthy eating, exercise, and physical activity combined

Your Mission: For Post-Op Patients If you haven’t started exercising, start now If you are already exercising See if you are meeting the discussed recommendations If not start setting goals to meet those recommendations Start thinking of ways to change your exercise routine Decrease boredom Increase chances of staying consistent

Starting Exercise THINK about how to add exercise into your life PLAN exercise into your weekly and daily schedule PRE-PLAN how to overcome barriers BEGIN your exercise program See your doctor first before starting an exercise program to ensure your safety

Exercise Goals Work towards 30 minutes of exercise throughout the day 30 minutes can be accumulated; can do three 10- minute bouts of exercise Monitor & improve pedometer steps each week Complete 3+ days of scheduled cardio days Complete 2+ days of scheduled resistance days Journaling your exercise can be quite helpful, just like food journaling It can help to see where you started and where you are currently to monitor progress It can help keep you focused on what to do It can keep you accountable to yourself

Questions? “Lets go exercise now!”