1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 8 Resistance-Training Strategies for Adult Obesity

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Obesity Epidemic in US US adults overweight = 66.3 percent –More than 32.2 percent also classified as obese Non-Hispanic blacks and Mexican- Americans have highest rates

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Obesity Ongoing trend over last three decades Framingham Heart Study showed long-term risks over 10- to 30-year period of becoming obese greater than 25 percent

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Obesity Defined Male’s average percentage of body fat –Normal = 15 to 18 percent –Obese = greater than 22 to 25 percent Female’s average percentage of body fat –Normal = 22 to 25 percent –Obese = greater than 35 to 38 percent

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Direct Costs of Adult Obesity Estimated at $75 billion dollars annually –Over eight years, 56 percent increase Related to comorbidities associated with obesity, including: –Diagnosis –Treatment –Physician visits –Hospitalizations

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Indirect Costs of Adult Obesity Lost worker productivity Lost income due to disability In 1995 study, estimated at $48 billion annually

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Adult Obesity Body weight regulation includes multiple factors: –Genetic –Hormonal –Metabolic –Dietary –Environmental

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Adult Obesity Not necessarily caused by sedentary lifestyle, lack of motivation, or noncompliance Primarily related to imbalances between energy intake and energy expenditure Obese individuals in state of positive energy balance Negative energy balance results in weight loss

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Body Mass Index (BMI) Calculated by dividing weight in kg by height in meters squared Ideal BMI range based on government and WHO recommendations Epidemiological studies assess relationship between weight and chronic disease

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. BMI Lower BMI means less risk for: –Cardiovascular disease –Hypertension –Diabetes –Several types of cancer –Associated comorbidities

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Limitations of BMI Quality of body weight not distinguished –E.g., fat vs. fat-free mass, bone, or protein Body builders, professional football players, and others with high amount of lean body mass relative to total body size classified as obese

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Limitations of BMI Exercise professional needs to consider both overall body mass and quality of body mass

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Body Fat Distribution Location of body fat Central adiposity –Android obesity –Excess body fat carried in abdominal area and trunk Gynoid obesity –Excess body fat carried in hips and thighs

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Central Adiposity Men = waist circumference of 40 or more inches Women = waist circumference of 35 or more inches Leads to greater risk for cardiovascular disease, diabetes, stroke, and certain cancers

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Central Adiposity Resistance training must target increases in total energy expenditure to decrease total body fat

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Resistance Training and Weight Loss Not recommended as substitute for aerobic exercise for weight loss –Which causes higher energy expenditures Unable to preserve loss of fat-free mass often seen during weight loss

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training Improves muscular strength, endurance, and overall mobility Used as complement to aerobic exercise during periods of weight loss

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training May help extremely obese resume activities of daily living Improves neuromuscular function, ability to perform activities of daily living, and aerobic exercise

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Recommendations for Aerobic Training Necessary to differentiate between exercise recommendations for weight loss versus other primary outcomes –E.g., muscular fitness Aerobic exercise through walking elicits greatest energy expenditure over fixed time period

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Recommendations for Aerobic Training 200 minutes of moderate-intensity aerobic, physical activity per week in combination with dietary restrictions promotes loss of 1 to 2 pounds per week

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Maintains or minimizes loss of lean body mass during periods of weight loss Helps individuals maintain fat-free mass and resting energy expenditure during weight loss –Particularly when targeting large muscle groups

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Needs, goals and abilities Functional capacity Limitations –Weight-bearing vs. non-weight-bearing, orthopedic, ROM, and flexibility Primary outcomes

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Screening Tests for Obese Adults Medical history Current medication use Weight history Body composition Primary care physician clearance

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Screening Tests for Obese Adults Exercise testing Monitoring of blood pressure before, during, and after training

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cautions Related to Medications Trainer should understand dosage, frequency, reason for prescription, and potential influences on resistance training responses Sibutramine may increase heart rate and blood pressure Orlistat may cause fecal incontinence, oily spotting, and flatus

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Weight History Consider history of average body weight Include weight gains and losses during adulthood Understanding can help determine individual’s motivation for changing behaviors Helps identify barriers to success

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Body Composition Combination of fat mass and fat-free mass Tool for assessing fat distribution and health risks Numerous anthropometric methods available –Refer to Table 8.4

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Resistance Exercise Testing May be inappropriate for some obese adults Determine risks following review of medical history and client consultation Testing protocols such as 1 RM for upper/lower body or multiple-RM tests generally safe Use either free weights or weight machines

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Incorporate progressive overload Consistently increase amount of work performed following adaptations

30. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Provide novices appropriate instruction, supervision, and feedback to ensure appropriate training stimulus/overload schedule Various scales exist to measure intensity

31. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. OMNI Scale for Resistance Exercise

32. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. ACSM Repetition Recommendations Healthy individual: –1 set of 8 to 12 repetitions for 8 to 10 exercises utilizing major muscle group Obese individual: –10 to 15 repetitions per set with lower load –2 to 3 sets per exercise

33. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Dynamic Activities Allow for greater ROM, slower, controlled rhythmical movements, and normal breathing pattern during lifting Include multi-joint activities –E.g., weight squats, seated chest press Mimic functional movements used in activities of daily living

34. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Resistance Training Machines May not fit obese individual and requires modifications Less likely to mimic activities of daily living

35. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Free Weights Require training and spotter Require balance and stability that may carry over to everyday activities Weight selection flexible –E.g., DBs, BBs, laundry detergent jugs

36. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Free Weights May include other equipment –E.g., resistance tubing, stability balls, medicine balls Variety and flexibility may promote compliance

37. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Behavioral Considerations Compliance especially problematic for sedentary and deconditioned individuals Many obese individuals choose exercise for reasons outside themselves –May hamper compliance

38. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Behavioral Considerations Measure motivational readiness for change to determine likelihood of compliance Review sample 24-Week Program

39. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Motivational Readiness to Change