More exercise for the obese?

Increased physical activity has usually not been considered a successful means to treat obesity because of the small and slowly occurring weight loss and bad compliance with exercise programs. Exercise has been advocated because it prevents the loss of fat-free tissues induced by hypocaloric diets. Muscular work may also elevate the metabolic rate for some hours after the cessation of exercise, but this requires high-intensity exercise. Instead, aerobic exercise may have more importance in ameliorating metabolic and hemodynamic disturbances often associated with obesity. Aerobic exercise of moderate intensity may increase serum high-density and decrease very-low-density lipoproteins, decrease serum insulin, and decrease blood pressure, especially during exertion. Similar alterations may also be achieved with a prudent diet alone, but inclusion of exercise provides more possibilities to vary the diet. A multifactorial approach (nutrition education, behavior modification and exercise) is needed to improve adherence to diet in mild and moderate obesity and to maintain weight loss. More than a formal physical exercise program for a couple of months, the obese need to include physical activity permanently as a part of everyday life.