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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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?

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 2010 Dietary Guidelines Same recommendations but add:
Increase physical activity & reduce time spent in sedentary behaviors

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

23. 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!

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

25. 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

26. 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

27. 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

28. Questions?
“Lets go exercise now!”