I have been approached to help develop some exercise programs for a clinically obese person who is taking medication for treatment. My background is in treating athletes and people who are not obese, by medical standards. Most of the research I've done deals only with diet and very little if anything is mentioned about physical activity. Do you have any recent information on studies done (success vs failure rates etc.)? Ideally, I am looking for a little bit more than "start walking."
Obesity is an interesting area. The medications/supplements that are available, both prescription and over the counter, seem to be effective. I am not sure what medications you are referring to in your question. However, most meds and supplements are more effective when coupled with exercise.
You have several concerns with a morbidly obese person (>30 BMI), the first is cardio-pulmonary ability. With an excess 50 to 100 pounds hanging on someone, it sometimes becomes difficult to open the thoracic cavity (chest area). The dynamics of pulmonary mechanics makes the attempt to broaden the bottom of the rib cage difficult as well, enlarging the area where the lungs are housed. This in turn draws air into the lungs. Exhaling is assisted by contracting the abdominals, internal and external intercostals and diaphragm. Seems like an elaborate explanation, but this is the reason why most programs for obese individuals advise them to "start walking."
Another consideration is joint trauma. Someone who is morbidly obese essentially has a fat suit hanging on them. This places increased demands on most joints, even the non-weight bearing joints like the shoulder-neck region and the wrists when they push themselves around or up off the floor, if that is possible.
My suggestions to you include the following:
Try interval training as it places less overall stress on the person during cardio training. Use the Borg Scale of Rate Perceived Exertion (RPE) ( 1= light, 10=max.) to judge training intensity. Keep the RPE intensity moderate (5-6) by their estimation, with a duration around four to five minutes. Slow the pace down to RPE 2-3 for two to three minutes and repeat efforts until a moderate level of fatigue occurs. At first, fatigue will not take long to occur, but as endurance builds, you can add repetitions.
Also, resistance training is a must. Research indicates people on meds who diet and exercise maintain more lean body mass than those who just diet. The speculation is that resistance training turns on the DNA-RNA sequence for protein synthesis and thus causes a nitrogen sparing effect. The training pattern to start with may be one to two sets, working at light resistance levels and full range of motion. Repetitions are in the 15 to 20 range with 30 to 60 seconds of rest. This will act like a circulation workout and keep the body temperature up, thus augmenting the thermogenic effect of the medicine your client is consuming.
Defining training and diets for clinically obese clients is very involved, but follow your common sense, and you can't go wrong. And of course, keep your client's doctor informed of everything you do.
- Daly,P.A.et al. Ephedrine, Caffeine and Aspirin: Safety and Efficacy for Treatment in Human Obesity. International Journal of Clinical Obesity. Vol.17, s73-78.1993
- Dulloo,A.G. Ephedrine, Xanthines and Prosatglandin-Inhibitors: Actions and Interactions in the Stimulation of Thermogensis. International Journal of Clinical Obesity. Vol.17, s35-40. 1993