Preference, Time Commitment Important in Helping Your Patients Choose and Stick to Their Exercise Routine

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.

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Dear Readers,

There are two recurring themes in my messages that often apply to various topics surrounding our specialty—“one size does not fit all” and “set realistic expectations.” From diet regimens to obesity intervention decisions, these mantras always seem to work their way into the conversation because, at their core, they promote the end goal of success. I apply these mantras again as we talk about physical activity in patients with obesity.

In this month’s issue, Anthony Auriemma, MD, JD, discusses high-intensity interval training (HIIT) versus traditional exercise in adults with overweight and obesity, an interesting and timely topic with the rise in popularity of HIIT-like programs, such as CrossFit and Orange Theory. HIIT is a form of physical activity where one performs a short burst of high-intensity (or max intensity) exercise, often called “on” intervals, followed by a brief low-intensity activity or “off” intervals. From my personal experience trying HIIT, I can say that it isn’t the exercise routine for me (I prefer racquetball and the stationary bike), but it likely has a place among a certain group of individuals. While available research on HIIT in the patient population with obesity is limited, I agree with Dr. Auriemma when he says, “the best exercise we can prescribe for our patients is the one they are willing to do.”

Our end goal as clinicians is to see our patients reach their health and weight loss goals, so we strive to provide the tools and resources that might help them along the way. This often means getting to know them as individuals and using motivational interviewing strategies to tease out what they think is realistic and achievable. Are they interested in HIIT, and can they commit to performing it consistently throughout the week? If so, then perhaps HIIT is the right exercise for them.

When considering an achievable exercise routine, time is always a consideration, which is not surprising given reports by the Centers for Disease Control and Prevention (CDC)[1] identifying the following about American’s exercise routines: fewer than 21 percent of U.S. adults meet the general recommendation for exercise behaviors, approximately 51 percent of U.S. adults meet the recommendation for aerobic (endurance) training, and 29 percent meet the recommendation for strength (resistance) training each week. Research shows that through HIIT, individuals might achieve the benefits of traditional continuous exercise training (e.g., increased cardiorespiratory fitness and insulin sensitivity) in 50 to 60 percent of the training time.[2–4]

I think that the interval aspect of HIIT addresses the concern of time commitments, which is appealing, especially to individuals who feel they cannot fit exercise into their daily routine. These “bursts” of activity that characterize HIIT can be applied in traditional exercise routines as well. If a patient finds it daunting or unrealistic to fit in one 30-minute workout session during their day, I suggest that they break it up into three 10-minute sessions, stressing that anything you can do to get your heart rate up, breathe harder, and break a brow sweat is beneficial to your health.

Though it is well known that “exercise is good for you,” we can further strengthen this message by explaining to our patients not only why it is good for you, but also when, meaning at what stage of the weight loss journey, it is absolutely essential.

During periods of significant weight loss, as seen in patients who have undergone bariatric surgery, individuals also lose lean body mass. Aerobic training and resistance training have been shown to reduce fat mass and body mass, and also increase lean mass in individuals with overweight and obesity.[5] This is crucial during the weight maintenance stage because it is our lean body mass that maintains our metabolism.

Another important benefit of exercise to share with your patients is in the area of bone health. Overweight and obesity correlate with an increased risk of osteoporosis.[6] In patients who have undergone bariatric surgery, particularly in Roux-en-Y gastric bypass and duodenal switch, there is malabsorption of calcium and vitamin D, which are essential to bone health. Exercise along with proper supplementation can improve bone health.

Lastly, it’s important to emphasize to patients that they do not have to approach their exercise routine with an all-or-nothing attitude. Actually, that approach is likely to set them up for failure. Instead, you might encourage them to just pick something, start small, and work their way up to higher intensity. Exercise programs often offer modified workouts to accommodate varying levels of physical fitness. Even if they cannot perform exercises at the highest echelon (e.g., the peak of the high-intensity interval during HIIT), they can still keep moving to reap the benefits of a regular exercise routine. Stay positive and check in with them during follow-up appointments. You can share in their victory when they tell you that a continuous exercise routine has given them increased tolerance and strength.

Sincerely,

Christopher Still, DO, FACN, FACP

References

1. Centers for Disease Control and Prevention (CDC). Adult participation in aerobic and muscle-strengthening physical activities–United States, 2011. MMWR Morbidity and mortality weekly report. 2013; 62: 326–330.
2. Keating SE, Machan EA, O’Connor HT, et al. Continuous exercise but not high intensity interval training improves fat distribution in overweight adults. J Obes. 2014;2014:834865.
3. Hood MS, Little JP, Tarnopolsky MA, Myslik F, Gibala MJ. Low-volume interval training improves muscle oxidative capacity in sedentary adults. Med Sci Sports Exerc. 2011;43(10):1849–1856.
4. Burgomaster KA, Howarth KR, Phillips SM, et al. Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol. 2008;586(1):151–160. Epub 2007 Nov 8.
5. Willis LH1, Slentz CA, Bateman LA, et al. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol (1985). 2012;113(12):1831–1837.6. Cao JJ. Effects of obesity on bone metabolism. J Orthop Surg Res. 2011;6:30.
6. Cao JJ. Effects of obesity on bone metabolism. J Orthop Surg Res. 2011 Jun 15;6:30.

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