Bariatric Times

AUG 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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12 Medical Methods in Obesity Treatment Bariatric Times • August 2017 THIS MONTH: High-intensity Interval Training versus Traditional Exercise in Adults with Overweight and Obesity by ANTHONY AURIEMMA, MD, JD Bariatric Times. 2017;14(8): 12–15. MEDICAL METHODS This column is dedicated to providing information on the medical management of obesity, which includes nutrition, physical activity, behavioral modification, and medication management. in Obesity Treatment Craig Primack, MD, FACP, FAAP Medical Bariatrician/Certified Medical Obesity Specialist/ C o-Medical Director, Scottsdale Weight Loss Center PLLC, S cottsdale, Arizona COLUMN EDITORS Wendy Scinta, MD, MS, FAAFP M edical Director, Medical Weight Loss of NY, BOUNCE Program for Childhood Obesity, Fayetteville, New York; Clinical Assistant Professor of Family Medicine, Upstate Medical University, Syracuse, New York INTRODUCTION In the era of the The Biggest Loser ® and "boot camp" style exercise regimens, the idea of starting an exercise program has become intimidating for many patients. The popularity of this form of exercise is demonstrated by the rapid growth of national chains like Orange Theory ® Fitness and CrossFit ® . These programs comprise exercise routines referred to as high-intensity interval training (HIIT). HIIT, also called high- intensity intermittent exercise (HIIE) or sprint interval training (SIT), 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. HIIT has been shown to improve cardiovascular fitness in less time than conventional exercise. 1 However, with the growing popularity of HIIT, clinicians might be wondering whether this form of exercise is safe and effective in the patient population with overweight or obesity, and might thus offer an alternative to traditional exercise. GUIDELINES FOR PHYSICAL ACTIVITY IN ADULTS Professional organizations provide evidence-based recommendations for exercise in the adult population. Although the available guidelines do not include HIIT in particular, they do address the numerous health benefits of regular physical activity, such as lower risk of premature death, coronary heart disease, stroke, hypertension, type 2 diabetes mellitus (T2DM), and depression. The Federal Physical Activity Guidelines, 2 released in 2008 by the United States Department of Health and Human Services briefly examines the relationship between physical activity and health, with a separate section discussing metabolic health. They state that lower rates of obesity-related comorbidities (e.g., type 2 diabetes mellitus [T2DM], high blood pressure), are seen with 120 to 150 minutes (2 hours to 2 hours and 30 minutes) per week of at least moderate-intensity aerobic activity. This is in line with its physical activity recommendations for general health benefits: 150 minutes per week of moderate intensity (e.g., brisk walking), 75 minutes of vigorous intensity (e.g., jogging), aerobic physical activity, or an equivalent combination. With the looming risk of weight regain after weight loss achieved by any means (e.g., lifestyle modification, pharmacotherapy, surgery), it is crucial that every exercise regimen considers what is needed to maintain weight and prevent regain. The Federal Physical Activity Guidelines address this with their recommendation of a minimum of 150 to 300 minutes per week of moderate physical activity to provide weight stability and more than 300 minutes per week if the goal is to lose and maintain greater than five percent weight loss. Studies further prove that exercise helps with weight maintenance. The National Weight Control Registry (NWCR), a longitudinal study established to examine characteristics of successful weight loss maintainers defined as "individuals who have intentionally lost at least 10 percent of their body weight and kept it off at least one year." One characteristic found among maintainers is high levels of physical activity representing approximately 60 minutes per day of moderate- intensity activity, such as brisk walking. The most common activity recorded in the registry is walking (76% of participants) following by weight lifting (20%) cycling (20%), and aerobics (18%). 3 Though published in 2008, the recommendations of The Federal Physical Activity Guidelines have been continually echoed by professional organizations and societies, many geared toward addressing the needs of individuals with overweight and obesity in particular. The 2013 American Heart Association (AHA)/American College of Cardiology (ACC)/The Obesity Society (TOS) guidelines for treating overweight and obesity 4 stated that strong evidence existed to support "a program of increased physical activity" be included in an effective high-intensity, on-site comprehensive-lifestyle intervention. Here, "increased physical activity" refers to aerobic exercise performed 150 minutes or more per week (equal to ≥ 30 minutes/day, most days of the week). Their recommendations for weight maintenance/prevention of weight regain are close to those The Federal Physical Activity Guidelines—approximately 200 to 300 minutes/week. The American Association of Clinical Endocrinologist (AACE) and American College of Endocrinology (ACE) comprehensive clinical practice guidelines, 5 released in 2014 include lifestyle/behavioral therapy recommendations for treating patients with overweight and obesity. Again, an ultimate goal of 150 minutes or more per week of moderate exercise is recommended in this patient population. In addition, they state that this exercise should be performed during 3 to 5 daily sessions per week. In addition, they recommended resistance training 2 to 3 times per week consisting of single-set exercises that use the major muscle groups in order to help promote fat loss while preserving fat-free mass. ABSTRACT High-intensity interval training, characterized by performing short bursts of maximum intensity exercise, often called "on" intervals, followed by performance of a brief low- intensity activity or "off" interval, has gained popularity worldwide. This form of physical activity has been proven to have similar health benefits as traditional exercise (e.g., moderate intensity continuous exercise), decreasing cardiovascular and metabolic risk factors, often in less time. However, studies have arrived at different conclusions regarding detailed physiologic measures experienced with HIIT. Here, the author presents available guidelines for physical activity in United States adults and discusses recent literature on high-intensity interval training in individuals with overweight and obesity so clinicians might better evaluate whether high-intensity interval training should be recommended in this patient population. KEYWORDS exercise, physical activity, high-intensity interval training, obesity, metabolic syndrome

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