Even if it doesn’t help you lose weight, physical activity is a real boon for the heart

Managing obesity requires a multi-faceted approach, but research suggests that people often fail to put this strategy into practice. A study published in JAMA Network Open on the experiences of 23 patients undergoing treatment with GLP-1 medications finds that people view these therapies as a support for lifestyle changes, and some report a greater willingness to engage in physical activity.

However, a study based on data from wearable devices worn by over 700 adults with obesity, which was recently presented at a conference, showed that, on average, patients actually reduced their physical activity after starting GLP-1 medication.

And this is a problem because these drugs also lead to significant loss of skeletal muscle, which is essential for healthy ageing and for regulating blood sugar levels. “Added to this is the fact that – as John Jakicic, professor of physical activity and weight management at the University of Kansas Medical Centre and president-elect of the American College of Sports Medicine, observes – muscle quality in people with obesity may already be compromised by high levels of fat infiltration in the muscles. What we see in studies, however, is that physical exercise actually improves muscle quality.”

The Physical Activity Guidelines for Americans (published in JAMA in 2018) recommend that adults engage in at least 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity activity, each week, in addition to muscle-strengthening exercises at least twice a week. However, experts at the AHA emphasise that even modest amounts of exercise can produce measurable health benefits for people starting from scratch. The important thing is to get started and keep at it consistently.

It is recommended that the ‘5A’ model be adopted to encourage patients to take regular exercise: Assess, Advise, Agree (on goals), Assist (provide support), Arrange (organise follow-up). The process begins by assessing what the patient is currently doing and their willingness to commit to physical activity. Next, information is provided on how to exercise, shared goals are set, strategies to overcome barriers are identified, and a plan is established to monitor progress.

Finally, the AHA recommends that objectives should follow the SMART model, meaning that they should be: Specific, Measurable, Achievable, Relevant and Time-bound.

Technology can help patients achieve these targets. Wearable devices such as pedometers, health apps and smartwatches can help patients monitor their progress with physical activity, boost their motivation and provide clinicians with objective data that can be used to give patients informed feedback.

Sometimes people are motivated to incorporate physical activity into their daily routine, but lack the time, resources or safe spaces to do so. And even in such cases, the doctor plays a crucial role in helping patients overcome these barriers and identify the resources available to them. And given that doctors also face time constraints, the help of other healthcare professionals (nurses, physiotherapists, dietitians and behavioural counsellors) is invaluable in providing more comprehensive support. “What we need is collaboration between clinicians and local resources that can support all aspects of patient care, including physical activity and exercise,” says Jakicic. “We do this for cardiac rehabilitation. Why shouldn’t we do the same in the treatment of obesity?”