9/2/2016. Faculty. Physical Activity and Obesity: How to Get Your Patients Moving. Learning Objectives. Disclosures. Identify the Target

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1 Faculty Physical Activity and Obesity: How to Get Your Patients Moving Deborah Bade Horn, DO, MPH, FOMA President, Obesity Medicine Association Medical Director Center for Obesity Medicine & Metabolic Performance Allison Family Fellowship Clinical Obesity Medicine and Metabolism Clinical Assistant Professor University of Texas Health Science Center Houston, Texas Disclosures Dr. Horn: Consultant - Novo Nordisk, Orexigen, Takeda; Scientific Advisor - Novo Nordisk; Speaker s Bureau - Novo Nordisk, Orexigen, Takeda Learning Objectives Explain the three levels of physical activity guidelines that affect patients with obesity Analyze the impact of moving from sedentary to light activity Utilize the three essential physical activity recommendations when counseling your patients with obesity Lower Your Risk of Mortality in the Next 28 Minutes Identify the Target The Challenge Stand Move Sit Stand Identify the target: The three levels of physical activity and the guidelines that affect patients with obesity Get leverage: Describe the impact of moving from sedentary to light activity Take action: The three essential physical activity recommendations What do you have to lose? 1

2 How Much Physical Activity Is Enough? General health benefit Moderate aerobic exercise 150 min/wk (about 30 minutes 5x/wk) + strength training Prevention of weight gain minutes per week minutes per week Prevention of weight regain minutes per week minutes per week Donnelly JE. Med Sci Sports Exerc. 2009;41(2): Physical activity guidelines for Americans. Office of Disease Prevention and Health Promotion website. Published Last updated July 26, Accessed July 26, Physical Inactivity in Adults No Leisure Time PA (LTPA) US 26.3 (Increased from 23.1%) 20% of US meeting Cardio/Strength Guidelines BRFSS 2013 survey data and documentation. Center for Disease Control website. BRFSS Telephone Survey Data Accessed February : Percent of Adults with No LTPA Exercise Dose-Response Curve CDC BRFSS Telephone Survey Data Accessed February 2, Church TS, et al. Arch Intern Med. 2005;165(18): Cardiorespiratory Fitness and Mortality Cardiorespiratory Fitness and CVD Death All-cause mortality by fitness groups, ACLS 2603 adults aged 60 years followed for 12 years P for trend <.001 Rate* Sui X. JAMA. 2007;298(21): *Per 10,000 man-years with adjustment for age and examination year. Church TS, et al. Arch Intern Med Oct 10;165(18):

3 Obesity vs Fitness Paradigm Get Leverage Identify the target: The three levels of physical activity and the guidelines that affect patients with obesity Get leverage: Describe the impact of moving from sedentary to light activity Take action: The three essential physical activity recommendations Ortega FB, et al. Circ Res. 2016;118: You Still Have 20 Minutes Left We spend the first 2 years of life teaching kids to walk and talk and then the next 16 years telling them to sit down and be quiet! How Many Hours/Day Are You Sitting? What do you have to lose? Come on, give it a try! Owen N, et al. Br J Sports Med. 2014;48(3): Standing vs Sitting and All-Cause Mortality Sedentary Behavior and Obesity Risk 6-year follow-up of 50,227 women in Nurses Health Study Each daily 2-hour increment of TV was associated with 23% increase in risk of becoming obese Each daily 1-hour increment of brisk walking associated with a 24% decrease in risk of developing obesity Katzmarxyk PT. Med Sci Sports Exerc. 2014;46(5): Hu FB. JAMA. 2003;289(14):

4 Sitting Time and Cardiometabolic Risk in US Adults Associations by Sex, Race, Socioeconomic Status, and Activity Level Self-reported sitting Elevated: Waist circumference, 2-hour post-load glucose BMI, triglycerides, insulin resistance Decreased: HDL Persisted across sex and race Strongest association in low/middle SES and no MVPA Take Action Identify the target: The three levels of physical activity and the guidelines that affect patients with obesity Get leverage: Describe the impact of moving from sedentary to light activity Take action: The three essential physical activity recommendations HDL = high-density lipoprotein; SES = socioeconomic status; MVPA = moderate and vigorous physical activity. Staiano AE. Br J Sports Med. 2014;48(3): You Still Have 15 Minutes What are you waiting for? 1. Don t Just Stand There or Maybe - Do! Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable Obesity? Diabetes mellitus? Heart disease? Make the most of every minute! Duvivier BM, et al. PLoS One. 2013;8(2):e doi: /journal.pone Epub 2013 Feb 13. Staiano AE. Br J Sports Med. 2014;48(3): doi: /bjsports Epub 2013 Aug Intensity Matters Resting VO 2 by Age and BMI Cardiorespiratory Fitness by Gender and Weight Status VO 2 max is significantly lower in obesity vs normal weight (P>.001) VO 2 = oxygen uptake. Wang CY, et al. Am J Epidemiol. 2010;171(4): Byrne NM, et al. J Appl Physiol. 2005;99(3):

5 PA Pre-Participation Screening PA Pre-Participation Screening (cont) Does not participate in regular exercise Participates in regular exercise Riebe D, et al. Med Sci Sports Exerc Nov;47(11): Riebe D, et al. Med Sci Sports Exerc Nov;47(11): START with the FUNdamentals Gravity-mediated PA options! Low/No impact and low-risk activities Aqua classes, water walking Recumbent bikes/elliptical trainers Walking Chair aerobics Balance training Strength training Low-Risk, High-Yield Physical Activity Tools Will I Choose an Active Life Today? What s the Take Home? Know your patients goals and give them a target! Maintenance requires high volume physical activity in 90% of successful maintainers Active activities of daily living matter! Teach your patients to self-monitor Meet your patients at their current ability level Identify resources, equipment, and evaluation needs for each patient individually Can it be fun? 5

6 Thank you for STANDING with me! Questions? 6