Abstract
Obesity is one of the greatest public health challenges of the 21st century. Overweight and obesity drastically increase a person’s risk of developing chronic non-communicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. Furthermore, obesity is already responsible for 2% -8% of health costs and 10% -13% of deaths in several industrialized countries. Lifestyle modifications involving changes in exercise, diet and psychological support are effective in reducing the incidence of overweight. Moreover, positive effects of physical activity (PA) for weight loss and prevention of weight regain are well documented. It was recognized that health benefits regarding both psychological and physiological aspects, such as improving cardiorespiratory and muscular fitness and/or decreasing depression symptoms, can be obtained from numerous activities. Public health institutions (American College of Sports Medicine, World Health Organization) provide recommendations for PA (volume, frequency, intensity and type of exercise) to achieve positive effects, at all ages and for many diseases and disorders situations. Although exercise under guidelines can be safely performed by obese subjects, several questions still need to be fully answered. In facts, the exercise program should be tailored according to an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals. Thus, this review analyzes the intensity of PA parameters. In the last years, research has been focused on the individualization of the right intensity in which different types of subjects’ condition must undergo to achieve the health goals. Aerobic exercise has been commonly used to reach weight loss goal. Prescription of aerobic exercise in clinical practice is frequently based on the percentage of maximum heart rate (%HRmax), heart rate reserve (%HRreserve), rating of perceived exertion (RPE), maximal oxygen consumption (%VO2max) and for unhealthy subjects, peak oxygen consumption (%VO2peak). It has been shown that unhealthy subjects, such as individuals affected by diabetes, obesity and cardiovascular diseases have a reduced maximal aerobic exercise capacity. For instance, using the formula based on percentage of HRmax or VO2max, it could be prescribed heavy exercises, which would result not appropriated and fully functional for the specific individual goal. To avoid this problem, another approach to individualize aerobic exercise could be to consider the gas exchange parameters such us aerobic gas exchange threshold (AerTGE). AerTGE corresponds to the first increase in blood lactate during incremental exercise. This review offers an overview of the different methods to assess exercise intensity, considering the different subjects health characteristics, in order to choose the right methods to achieve the health goals in obese and overweight subjects.
Highlights
In the last century, chronic diseases, known as non-communicable diseases (NCDs), have become the most serious public health problem in terms of morbidity, mortality and economic costs [1]
The AerTGE is defined as the maximum exercise intensity fully supported by aerobic metabolism, representing in general a mild to moderate exercise intensity [77,78]
Since overweight and obese subjects have a low cardiorespiratory capacity and low exercise tolerance, the prescription of the intensity of exercise should be based on the real individual capacity to perform physical exercise
Summary
Chronic diseases, known as non-communicable diseases (NCDs), have become the most serious public health problem in terms of morbidity, mortality and economic costs [1]. Overweight and obesity are commonly defined as abnormal or excessive fat accumulation that presents a risk to health These conditions are usually assessed in clinical setting using the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres) (BMI = weight [kg] × height [m−2]). Studies showed that subjects who increased their level of PA over time have a decreased risk of mortality compared to those who were consistently unfit [5,6,7] Despite these positive effects, physical inactivity remains an international health problem and its negative effects on health were well documented [8] as well as the negative economic consequences [9,10]. This paper could be useful for professional figures working to achieve and maintain fitness: physicians, health practitioners, kinesiologists, and exercise physiologists to update the knowledge of the different approaches for prescribing exercise intensity for obese and overweight subjects
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