Physical activity as one of the pillars in the prevention and treatment of overweight and obesity

INTRODUCTION

Everyone knows the word obesity, but its meaning is interpreted differently. It depends on the cultural, historical, social, and family environment in which a person lives. We define obesity as an increase in body fat above 25% in men and above 30% in women, a risk factor in the development of other diseases, a chronic progressive disease characterized by fat accumulation with multiple organ-specific pathological consequences that strongly affect morbidity, quality of life, and longevity of the obese individual. Its development is conditioned by genetics and environmental influences. The most effective method of reducing body weight is the comprehensive obesity management proven to consist of four pillars: nutrition, physical activity, lifestyle change, and appropriate pharmacotherapy. Obesity treatment should be comprehensive, individualized, and primarily in the hands of professionals [1,2,3]. Movement is one of the basic expressions of life, a means to meet essential life needs and a tool for adaptation to constantly changing conditions.

Physical activity is skeletal muscle movement that increases energy expenditure above resting levels. We include leisure activities that we do not perform during ordinary daily activity and that cause energy expenditure to rise above the level observed during rest, as well as occupational physical activity, which includes tasks related to performing a job. Physical activity leads to a reduction of both subcutaneous and visceral fat [5]. Regular exercise can positively affect body composition, metabolism, structure and function of fat, skeletal muscle tissue, pancreatic β cells, and other tissues even with minimal reduction, and even without change in body weight. In combination with healthy nutrition, it has the potential to reduce morbidity and improve quality of life and well-being in people of all ages [4,5,6].

In the prevention and treatment of obesity, aerobic activity is recommended, although the positive effects of strength training are also known. Appropriate activities include swimming, cycling, and walking. Frequency, duration, and intensity of exercise depend on a person’s capabilities and preferences. Inappropriate physical activity carries a risk of injury to the locomotor system, so selecting a suitable activity type is important [4,5,6,7].

AIM

The study examined whether increased physical activity before participation in a body-weight reduction program positively influences the reduction of selected anthropometric indicators of overweight and obesity after completing the weight-reduction program.

SAMPLE AND METHODS

The research sample consisted of 244 respondents (60,7% women (n=144) and 39,9% men (n=96)), aged 20–65 years. Participant selection was purposive. We included men and women with overweight or obesity who sought our center with an interest in reducing body weight, and respondents after bariatric surgery who had not maintained their target weight. Respondents with endocrine-related obesity, where weight gain may be a secondary symptom and where conservative obesity treatment without targeting the primary cause might not produce changes comparable to those of this sample, respondents with diabetes mellitus, and respondents taking weight-reducing pharmaceuticals were not included. We followed basic ethical approaches for research. Data collection took place at the Center for Health and Nutrition in Zvolen and Bratislava. We monitored somatic indicators of body weight, waist and hip circumference, BMI, and WHR, with emphasis on intersex differences. To map respondents’ physical activity we used the Baecke questionnaire, which consists of 16 items mapping the level of physical load during work activities (8 items), sports activities (4 items), and leisure-time activities (4 items) [8]. The collected data were statistically evaluated using SPSS version 22.0 and Excel. The significance level was set at α = 0,05.

RESULTS

We identified the total movement index with the Baecke questionnaire. In men and women, we related it to selected anthropometric indicators of overweight and obesity and found that between the overall movement index and the changes in body weight, waist circumference, BMI, WHR, and visceral fat there is no statistically significant relationship in either sex after the intervention (Table 1, 2).

Table 1 Relationship between total movement index and selected anthropometric indicators of overweight and obesity in women

Table 2 Relationship between total movement index and selected anthropometric indicators of overweight and obesity in men

Between the work index and changes in body weight, waist circumference, BMI, WHR, and visceral fat after the intervention no statistically significant relationship was found in men, and we found the same in observed women (Table 3, 4).

Table 3 Relationship between work index and selected anthropometric indicators of overweight and obesity in men

Table 4 Relationship between work index and selected anthropometric indicators of overweight and obesity in women

Between the sports index and changes in body weight, waist circumference, BMI, WHR, and visceral fat after the intervention no statistically significant relationship was found in men (Table 5).

Table 5 Relationship between sports index and selected anthropometric indicators of overweight and obesity in men

Between the sports index and changes in body weight, waist circumference, BMI, and visceral fat after the intervention no statistically significant relationship exists in women. Between changes in WHR and the sports index, there is a positive, statistically significant relationship (r_S=0,2013,p=0,01). The higher the sports index, the greater the WHR difference. The strength of this relationship is weak (Table 6).

Table 6 Relationship between sports index and selected anthropometric indicators of overweight and obesity in women

Between the free-time index and WHR we found a statistically significant positive relationship in men (r_S=0,211,p=0,039). The higher the free-time index, the greater the WHR difference. The strength of this relationship is weak, and in other cases relationships were not statistically significant (Table 7).

Table 7 Relationship between free-time index and selected anthropometric indicators of overweight and obesity in men

Between the free-time index in women and changes in body weight, waist circumference, BMI, WHR, and visceral fat after the intervention there is also no statistically significant relationship (Table 8).

Table 8 Relationship between free-time index and selected anthropometric indicators of overweight and obesity in women

DISCUSSION

A dominant feature of today's lifestyle, in addition to unhealthy eating habits and stress load, is the much greater share of sedentary living. Time for recreation and rest has been replaced by television, mobile phone, and computer, which negatively affects individual health and contributes to the obesity pandemic. From several epidemiological studies it is known that regular physical activity is effective not only for obesity prevention and treatment but also for reducing associated health risks. It is alarming that most of the world population does not engage in the necessary amount of movement in daily life. Up to two-thirds of Slovaks suffer from lack of physical activity, and a similar situation exists in the USA, the United Kingdom, and other countries.

In studies that have followed the Slovak population, among lifestyle risk factors, inadequate physical activity is foremost, especially for women [9,10,11,12]. Results of our study showed that between physical activity obtained before participation in the reduction program and selected anthropometric indicators of overweight and obesity after completing the preventive program, no statistically significant relationship exists in men (p > 0,05) or in women (p > 0,05).

With a more detailed examination of relationships between individual indices, we found no relationship between work index and selected overweight and obesity indicators among men (p > 0,05) and women (p > 0,05). The same was true for the sports index in men (p > 0,05), women (p > 0,05), and for the free-time index and selected overweight and obesity indicators in women (p > 0,05). In men, no statistically significant relationship was found between free-time index and changes in body weight (p > 0,05), waist circumference (p > 0,05), BMI (p > 0,05), or visceral fat. The only statistically significant relationship was found for the free-time index and the change in WHR, where higher physical activity in men’s free time was associated with a greater increase in the WHR difference after completing the preventive program (r_S = 0,213. p < 0,05).

From the Baecke questionnaire analysis within the longitudinal obesity prevalence study in Czechia, “Životný styl a obezita,” it emerged that people with normal weight have greater physical activity in free time and sports, while people with excess body weight have greater physical load at work. Tehard et al. [13] found that the work index does not correlate with general and abdominal obesity indices, and it is known that low energy expenditure in many professions leads to low variability in work-related physical activity, a finding we also support.

In our respondent group, no profession had high physical activity, and only a very small percentage in work always stands (3,28%, n = 8), never sits (3,28%, n = 8), always walks (2,46%, n = 6), always lifts heavy loads (0,82%, n = 2). The authors also present the finding that physical load during sports negatively correlates with WHR and WHR does not correlate with leisure-time activities. Our results did not confirm such conclusions, but it is important to note that the sample consisted of clients with overweight and, to a greater extent, obesity of grade 1 to 3. One explanation for our findings is possible distortion: overestimation of physical activity volume, where respondents may have wanted to present themselves in a better light in the questionnaire, while reality may have been different. For adults, a minimum of 30 minutes of moderate physical activity daily is appropriate (walking, cycling, games, housework, gardening, dance, sport). For body-weight regulation, moderate physical activity is recommended in a duration of 250–300 minutes per week. Positive effects of physical activity on health are related to the reduction of visceral fat and decreased accumulation of ectopic fat in organs and tissues.

Moderate-intensity exercise for one hour per day, with unchanged energy intake, leads to a reduction of waist circumference of about 0,5 cm per week [4]. In studies examining the negative association between physical fitness, activity, and adiposity, low leisure-time activity was shown to increase obesity risk threefold in men and fourfold in women. Adults with higher physical fitness have smaller waist circumference and less visceral and subcutaneous fat compared with sedentary individuals of similar age, sex, and comparable BMI. 3–4 month training studies indicated a significant drop in waist circumference, as well as amounts of visceral and subcutaneous fat in obese individuals without accompanying body-weight change. These findings inform people trying to lose weight through exercise and may be demotivating if body weight declines slowly.

Regular exercise is an inseparable part of preventive strategies, but the most optimal results are expected from combining caloric restriction with exercise. Regular sports activity is the most important supportive element in managing weight regain prevention and the strongest predictor of normal weight [10]. We found that between physical activity obtained before participation in the weight-reduction program and selected anthropometric indicators of overweight and obesity after completing the preventive program (body weight, waist circumference, BMI, WHR, visceral fat), no statistically significant association exists in men (p > 0,05) or women (p > 0,05).

With a more detailed examination of relationships between individual indices, we found no relationship between work index and selected overweight and obesity indicators in men (p > 0,05) and women (p > 0,05). The same was true for the sports index with selected overweight and obesity indicators in men (p > 0,05), women (p > 0,05), and for the free-time index with selected overweight and obesity indicators in women (p > 0,05). In men, no statistically significant relationship was found between free-time index and changes in body weight (p > 0,05), waist circumference (p > 0,05), BMI (p > 0,05), and visceral fat.

Only one statistically significant relationship was found for free-time index and change in WHR index, where the higher men’s physical activity in free time, the greater the increase in WHR index difference after completing the preventive program (r_S = 0,213. p < 0,05). On this basis, we propose that if a respondent had higher physical activity before the program started, adapting that activity during the program would be easier for them, and therefore the reduction of total body weight, BMI, waist circumference, WHR, and visceral fat would be more pronounced than in a respondent with lower physical activity.

CONCLUSION

A sedentary lifestyle has increased significantly in modern lifestyles. People are negatively socially motivated toward lower daily energy expenditure, which leads to a dramatically increasing range of risks leading to civilization-related diseases. Deficit of physical activity now represents a problem for almost everyone.

The relationship between physical activity and overweight or obesity is complex. It is generally accepted that lower physical activity is linked to weight gain over time, and conversely increasing body weight and obesity lead to reduced physical activity [6,13]. Physical activity is an inseparable part of obesity treatment and has an equal role in prevention of obesity and related diseases. It contributes to body-weight reduction, prevents weight gain and the development of metabolic and cardiovascular diseases, and reduces mortality from all causes.

Autorka: PhDr. Mgr. Ing. Trnková Ľubica, PhD. MPH VŠ ZaSP sv. Alžbety, Detašované pracovisko bl. Sáry Salkaházi, Rožňava

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