Study: Medically supervised exercise program improves fitness, mobility in obesity patients

September 7, 2012 — Obesity is a gateway disease that contributes to many medical problems including coronary heart disease, stroke, type 2 diabetes and cancers, as well as mental disorders.

In 2008, the overall medical care costs related to obesity in the U.S. were $147 billion. Despite the availability of guidelines to treat obesity in the U.S., the prevalence of obesity is still rising, estimated to affect 165 million Americans by 2030.1

Recognizing that traditional medical management of obesity patients was not enough and innovative strategies to treat obesity were critically needed, a multidisciplinary weight loss clinic, the Energy BALANCE (Behavior And Lifestyle Assessment with Nutrition Centered Education) was established at the University of Nevada, Reno in 2010. This clinic utilizes a team?approach to evaluate, motivate and effectively treat patients with obesity.

Mary E. Sanders, PhD, FACSM, RCEP, clinical exercise physiologist, Wellness and Weight Management Clinic, University of Nevada School of Medicine, Reno, recently employed this multidisciplinary team approach to study the effectiveness of a clinical weight loss program on selected anthropometrics and mobility in obese patients.

“Mobility disability is prevalent in the older population, yet little is known about the effect of obesity and weight loss on mobility in the younger populations,” stated Sanders. “If we can improve an individual’s mobility and balance, they’re more likely to become active, embrace an exercise program, and experience changes quicker than if they are just focused on a nutritional program and measured success only by weight loss. However, we knew that we needed an effective, inexpensive and convenient tool that allowed our patients to exercise independently and sustain a high level of compliance. The Thera-Band First Step to Active Health proved to be the perfect tool, the ‘no excuses’ gym that is like a personal trainer in their pocket or purse.”

The 12-week weight loss and mobility study, developed by Dr. Sanders, Katie B. Lyons, MS III, and Quang T. Nguyen, DO, FACE, was conducted by a team of physicians, registered dieticians and clinical exercise physiologists on 66 patients. All patients received medical, nutrition and physical activity assessments with weekly follow ups; education on weight loss behavior and lifestyle strategies; and tracking and guidance. The physical activity visits included mobility assessments that measured lower and upper body muscular strength, balance, shoulder flexibility and the number of average steps taken per day.

Over the 12 weeks, patients significantly reduced weight and percent body fat (6 percent), increased upper body strength/power (18 percent) and lower body strength/power (27 percent), and increased daily stepping 58 percent. Periodic follow ups measuring mobility improvements kept patients motivated to continue. At the end of the program over 20 percent of the pre-bariatric patients decided to opt out of surgery.

A principal component of the study was the Thera-Band First Step to Active Health kit, a comprehensive, customizable, and progressive activity program, and an Accusplit 120-XL pedometer with step-tracking instructions. Individualized home/gym exercise programs based on American College of Sports Medicine (ACSM) guidelines for physical activity and the First Step to Active Health program were designed for patients and progressed over time.

The First Step to Active Health kit contains a red Thera-Band Exercise Band and an evidence-based exercise program focusing on improving cardio fitness, flexibility, strength and balance. A free companion guide for healthcare providers, The Active Aging Toolkit, explains the scientific foundation for the interventions, provides tools to assess and individualize activity programs, and discusses strategies to encourage adults to become more active. Patients used the exercise kit to build strength and improve balance and flexibility thru specific exercises.

“Patients loved the First Step kit because it has photos, directions, a band and instructions on simple exercises that ‘fit in’ to a busy day. When team providers followed up by asking how the exercise program was going, the patients couldn’t use the excuse that they couldn’t get to the gym!” continued Sanders.

In June, Sanders presented the team’s findings at the American College of Sports Medicine’s Annual Meeting in San Francisco. This research was also featured at the 14th annual Performance Health Scientific Advisory Committee meeting that was held July 23-25, 2012 in St. Johns, Newfoundland, Canada.

“We are honored to have Dr. Sanders serve on our Scientific Advisory Committee, which brings the latest research to us to help fellow clinicians make evidence-led decisions that ultimately benefit both patients and clients,” said Dr. Phil Page, director of clinical education and research for Performance Health. “The First Step to Active Health program is obviously a very effective and versatile tool to prescribe physical activity programs for a variety of patient populations. We’ve seen successful outcomes using the program in sedentary older adults, patients with diabetes, osteoporosis, and now obesity.”

This study’s findings also included:

• Within a clinical setting, an integrated multidisciplinary team that includes a clinical exercise physiologist can help obese patients improve both their weight and mobility. Measures revealed significant improvement in all areas. View study abstract here.
• Older adult-based mobility assessments may provide useful data for designing exercise prescriptions for younger obese adults.
• Mobility assessments can provide encouragement as patients experience changes related to their quality of life outside of weight measures.
• Without access to a fitness facility, the First Step To Active Health is an effective tool for patients to achieve weight and mobility goals within an office or home-based setting.

Source: Performance Health, thera-band.com

References

¹Multidisciplinary approach as best practice for the treatment of obesity patients. Shien Hu, MD (Associate); Raymond A. Plodkowski, MD (Member); and Quang T. Nguyen, MD (Member) Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV; acponline.org/about_acp/chapters/nv/abstract12_hu.pdf