Physical Activity in Obesity Management for Health, Function and Quality of Life

Key Takeaways

Physical Activity in Obesity Management for Health, Function and Quality of Life

Physical activity and exercise training are important components of comprehensive obesity care, with benefits extending beyond weight outcomes. Across obesity management pathways, movement supports improvements in body composition, cardiometabolic health, mobility, physical function, mental wellbeing, and quality of life.

Clinical Benefits and Functional Outcomes

Increasing physical activity levels and reducing sedentary time support overall health and long-term care. Structured exercise training, including aerobic, resistance, and functional approaches, can improve fitness, preserve muscle mass, support symptom management, and enhance physical capacity. These benefits are particularly relevant for people with multiple health conditions, reduced mobility, or low fitness.

Assessment and Personalised Support

Support should begin with assessment of current activity levels, physical function, strength, mobility, clinical status, and barriers to participation. Tailored recommendations should reflect previous experience, preferences, treatment stage, and outcomes that are meaningful to the person, using realistic and sustainable progression.

Integration Across Obesity Care Pathways

Physical activity support and exercise strategies should be integrated across multidisciplinary obesity care, including behavioural treatment, pharmacotherapy, and bariatric surgery pathways. Clinically meaningful outcomes include improved function, confidence, symptom relief, independence, and quality of life.

Future Directions and Next Steps

• Collaborate to strengthen activity and function assessment within COMs pathways
• Expand outcomes beyond weight to include fitness and quality of life
• Support tailored movement strategies for people with complex obesity phenotypes
• Increase education for multidisciplinary team members on physical activity and exercise within chronic disease care

Additional Q&A

Q1: We are starting a project with sedentary patients with overweight and obesity. We have a plan to have high-intensity exercise training. What is your recommendation to start the HIIT intervention with people living with overweight or obesity?

A1: Before starting HIIT, ensure a thorough cardiovascular screening and functional assessment is carried out 

Q2: CPET or 6MWDT – do you use these in your daily routine? Is CPET useful for people living with obesity?

A2: In my routine I provide CPET – that is very useful in people with obesity in order to describe the particular functional limitation and to provide a very individualised exercise prescription and cardiovascular screening.

Q3: Do you have any guidance on how best to ensure adequate protein intake for patients being treated with obesity management medication as part of comprehensive care?

A3: Thank you for your important question. We don’t know the optimal protein intake to preserve muscle mass and function during treatment with OMMs. However, as shown in the presentation, 1.2 g protein per kg actual or adjusted body weight has been suggested in a couple of narrative reviews. This can be calculated and advised, but in a clinical setting you may ensure that the patients have at least 3 meals containing protein rich foods per day. It may be necessary to advise about protein-enriched yoghurt and milk.

Resources

• Oppert J-M, Bellicha A, vanBaak MA, et al. Exercise training in the management of overweight and obesity in adults: Synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group. Obesity Reviews. 2021;22(S4):e13273. https://doi.org/10.1111/obr.13273
• Busetto, L., Dicker, D., Frühbeck, G. et al.A new framework for the diagnosis, staging and management of obesity in adults. Nat Med 30, 2395–2399 (2024). https://doi.org/10.1038/s41591-024-03095-3
• EASO Framework for Obesity Diagnosis, Staging and Management further information

Summaries are AI-generated from meeting transcripts.

Transcripts are auto generated, if you spot an error, please email enquiries@easo.org

Speaker 1 • 00:00
Hi, I am happy to welcome you to this month’s EASO COMMS webinar on Physical Activity in Obesity Management for Health, Function and Quality of Life. Thank you for joining. My name is Mette Svensson. I am in the EASO Sarcopenic Obesity and Obesity in Older Adults Working Group and I will chair this webinar and I’m really looking forward to the presentations and discussions today. Our excellent speakers are Professor Jean-Michel Lepin, he will talk about physical activity and obesity, evidence beyond weight loss. He is the co-chair of the IASO Physical Activity, Fitness and Function Working Group and his positions are at the Department of Nutrition, Sorbonne University in Paris, France. The second speaker is Dr. Francesca Battista. She will talk about embedding exercise into CAMHS care pathways. She is also a member of the EASO Physical Activity Group and her position is at the Sport and Exercise Medicine Division at the University of Padova, Italy. Today we will learn about the limited additional impact of exercise on body weight, the important additional impact of exercise on other outcomes such as body composition, fitness and cardio metabolic health. We will also learn how to design in person-centered exercise programs that prioritize health and quality of life, and how to integrate structured exercise into multi-disciplinary obesity care. Before that, I have some information. The webinar is being recorded and uploaded to the EASO video archives soon after the session. I will also mention that these monthly comms webinars are held to share knowledge and expertise across the EASO comms network to enhance obesity management and patient care, and I will encourage you to share the webinars with your colleagues. I will also encourage you to use the Q&A section to ask questions, which will be addressed at the end of the webinar. Please complete the anonymous feedback forms. Your comments are valuable for improving future webinars. At last, but not at least, I will highlight the European Congress on Obesity in Istanbul on 12 to 15 May. Please register to join. We are preparing excellent workshops both on physical activity and body composition and function. This is enough talking from me. I will now hand over to the speakers. Please, Jean-Michel, the screen is yours.

Speaker 2 • 03:52
Thank you. Thank you very much, Mette. And thanks to Yesu for this opportunity to discuss with you this morning physical activity and obesity. So I will start right away and talking about the starting point here which is the general context of the person living with obesity and physical activity. So let’s just imagine a person living with obesity and physical activity from the angle of behavior, physiology and comorbidities. So what we have on the left and right is usually we have these low physical activity levels in general, in persons with obesity. Usually we have a low percentage of persons reaching the public health physical activity guidelines. And most importantly, we have also low levels of fitness, including cardiorespiratory fitness and muscle strength. and I know my colleague Francesca Battista will develop these issues. We have also on the right hand side in this person’s multiple comorbidities, which will impact on physical activity possibilities and also on mobility. And in this context, we have many false hopes on physical activity, especially regarding weight loss. We have sometimes mixed past experiences with physical activity and sports in persons living with obesity and variable degrees of motivation. And on top of that, we have a high social pressure, not only for weight loss, but also for increasing physical activity. We have high medical pressure, not only for weight loss but to increase physical activity and although there are multiple barriers to physical activity and sometimes limited access to programs and facilities. But the good news is that even small changes in the daily or weekly volume of physical activity allows to increase cardiorespiratory fitness, which is such a potent and important risk factor for health. And even small changes in cardiorespiratory fitness are associated with substantial improvements in health and mortality. And so this does fit very well with the current physical activity recommendations for the general population. This is not specifically for persons with obesity, but it’s a useful landmark for persons living with obesity. As you all know, recommendations are to perform at least 100 to 150 to 300 minutes per day of at least moderate intensity endurance or aerobic activity, plus a bit of strength training every week. We know that more is better, but what is so important in these guidelines is stated on the right hand side of the slide. Any activity is better than none and it’s clearly stated that adults who do any physical activity and also sit less get health benefits. So, this is for the general population, but we think it really does apply very well to those persons with obesity. Now, let’s turn to the effects of exercise training on weight and non-weight general health outcomes. For this, I will rely on the work that we have been doing within EASO, in a Physical Activity Working Group, also with Francesca Battesta. And we have done several reviews and meta-analysis on these topics and provided recommendations. And all this is freely available in obesity reviews. So this work and further reviews have really emphasized the many benefits of physical activity beyond weight loss. I’ll go back to weight loss, but beyond weight loss. So physical activity or exercise training allows to improve body composition, cardiometabolic health, physical fitness, quality of life and even probably eating behaviour. So this is what we are going to see in a bit more detail now. So if we turn to weight loss first, the reviews that we have performed and many other reviews conquer to the fact that, yes, physical activity does allow significant weight loss when you compare in controlled trials subjects with overweight or obesity who exercise versus subjects who do not exercise. It is significant. However, it is not substantial. The average difference that you can see here in the second column, that is the effect magnitude of this comparison between exercise and no exercise, is only on average from 2 to 3 kilos. So, this is very important to bear in mind. and this is, I would say, the backbone of this presentation on non-weight benefits of physical activity. And this is mostly seen with endurance training, at least of moderate intensity, and about the same as the recommendations. Now, if we look at other outcomes of interest, On the left column, you can see all the outcomes of great interest in obesity management, going from fat mass loss to improvement in metabolic control. So, if we look at weight loss, we address that. Now, fat mass loss, you can see it’s very similar to weight loss with a mean difference that is significant but not substantial, and mostly with endurance training. There is interestingly some loss in abdominal visceral fat with exercise training even in the absence of weight loss. And this is not trivial, 2-3 cm in waist circumference, also mostly with endurance training. Most importantly, the improved CRF, Cardiorespiratory Fitness, and this is substantial because 10-15% increase in CRF is associated with 10-15% decrease in mortality, mostly with endurance or combined training. For weight maintenance after weight loss, we know that exercise can help, but only if The volume of exercise is relatively high, 200 to 300 minutes per week of endurance training. We know that exercise can help with preservation of lean mass during weight loss, and this is mostly or only with resistance training. Exercise training can also increase muscle strength, and the increase here is important. resistance training or combined training and we all know that exercise training in those with type 2 diabetes can improve metabolic control. So you can see here the many benefits of endurance training but the very specific effects of resistance training on muscle mass and muscle strength. So there is this This question about why is it that exercise does not really induce substantial weight loss. So, there are a number of reasons. I will go very briefly through some of the arguments. First, activity energy expenditure is small. There could be some compensation in basal energy expenditure when activity energy expenditure increases. We always have to think that when we are adding exercise training in obesity management we are most usually in an energy deficit phase and the energy deficit will impair the effects of exercise on body weight and composition. And then there could be concurrent changes of course in eating behavior. However, in the reviews that were performed in our group, it was shown from controlled studies that concurrent changes in eating behavior with exercise training in subjects with overweight or obesity was associated with improved eating behavior, increased fasting, hunger, increased satiety, less uncontrolled eating and improved preferences. So this is the general picture. Now I would like to briefly address two specific situations that I think are of great interest today. The first one is bariatric surgery, and the second is the treatment with the GLP-1 receptor agonists. For bariatric surgery, this is a review that was performed by my colleague Alice Belicha our ESO group and you can see the effect of exercise training on after bariatric surgery compared to subjects without exercise training. On weight loss it’s very similar to non-bariatric patients. You can see the mean difference between exercise and non-exercise is about 2 kilos. So there is an additional effect of exercise but it’s of small magnitude. However, there are important and substantial effects on cardiorespiratory fitness, muscle strength and function such as the distance walked during the six-minute walking test. And these are standardized main differences. So these are important effects. So this is important. there is an optimization of the results of biatric surgery with exercise. The second specific situation is the treatment with GLP-1 receptor agonists. There are lots of comments, commentaries, discussion papers on this topic, but there are not so much real actual data. So this is one of the best studies I think, where you can see about 215 people with obesity, two-thirds women, mean BMI 37, first underwent an 8-week VLCD and they lost about 13 kilos. Then they were randomized into four groups. Placebo, exercise, which was relatively high intensity exercise, several times per week, L-Rugletide and 3 mg per day and then exercise plus L-Rugletide. As you can see here, those subjects in the combined group, exercise plus L-Rugletide were those who maintained best their weight. Actually, placebo regained weight, exercise regained a bit of weight, L-reglutide were a stable weight and those in the combined group lost 9 kilos versus the placebo. In parallel, those in the combined group lost the highest amount of fat mass, retained some lean mass and there were also those who increased the most cardiorespiratory fitness. So, this is a very interesting study, one of the best studies in the field, I think, on this topic. Now, as you know, there might be increased loss in lean mass with these medications, and so there are lots of hypotheses about the interest of exercise and specifically resistance exercise to optimize body composition changes with the medication. So it is hypothesized that, for example, resistance training will optimize fat mass loss during treatment and will help prevent fat mass regain and it would also help with maintenance of lean mass during treatment and maintenance after treatment. But there is no published evidence to my knowledge on this topic yet. Now a few words about the counselling strategy. I know Francesca will tell you more about it. I want just to show you the general framework for physical activity counselling and exercise training in this setting. We usually use the five A’s. The five A’s framework starts with ask. Every encounter with the patient is an important opportunity to discuss about physical activity. Then second A is for assess, assess physical activity with questions, questionnaires, smartphones, accelerometers and sometimes assess physical capacity. Francesca will tell us about it. Third day is for advice, meaning we need to define the goal. What is the goal? Is it to preserve lean mass? Is it to improve metabolic control, is it to improve quality of life? And then we have to agree on the program we will propose to the patients. I think currently the best buy is to combine exercise endurance and resistance exercise and perhaps with obesity medication to increase protein intake. Then the final A is for assist, which is perhaps the most important. Identify barriers to physical activity, identify the relevant professionals to help the patient with activity and identify the opportunities, the resources, the facilities in the living environment of the patient where he/she can perform physical activity. So what I wanted to tell you about is summarized here. Specificity means we should think of exercise with specific effects, such as resistance exercise to increase muscle strength. We should only look at sizable effects, and this is beyond weight loss. We should try to not harm the patients, of course, because sometimes with the best intentions, we don’t have the best results. This is really a pathway, increasing physical activity in a progressive and graded way. And of course, the ultimate challenge on the long term is to increase adherence. So with this, I will thank you very much for your attention and we’ll give the floor back to Mete. Thank you.

Speaker 1 • 22:14
Thank you, Jean-Michel. And now we are going directly over to Francesca. Francesca, please, the screen is yours.

Speaker 3 • 22:34
So, thank you very much. Can you see my presentation? Yes. Okay. So, thank you, Matt. Thank you to Iaso for this invitation and thanks to Professor Jean-Michel Oter for this important and focus on the first part of this webinar. Now my job is to go through how to make all these evidences in practice, how to translate all this knowledge in a practical approach with patient and in real healthcare pathways in order to make this evidence, this knowledge, this benefit from physical exercise feasible and reliable for our patient. So, first of all, I want to start with the solid convention about the importance of a multidisciplinary approach in order to promote, in order to implement physical activity and lifestyle change in patients with obesity. We have to implement our activity in a multidisciplinary team because Obesity is a complex disease with many, many physiological pathways that are involved. So we have to manage this problem with multifaceted solutions. So we have to build a solid multidisciplinary team together with other specialists, together with other professionals that manage the whole lifestyle change process. And it is very useful and it is very a goal to achieve a global health benefit. So also sleep quality is important, also mental health is important, also social well-being is important in order to improve the global health of people with obesity, in order to have a patient-centered approach in people with obesity. So after this first aim, we have to go through these five strategies and understand how to put it in practice, in our daily practice, in the management of the patient. So we already have seen what are the definitions of these five A’s. And now we go through this definition, understanding how to make in practice these principles. So first of all, we have to ask. We have to ask about, yes, of course, about medical history, about previous medical check about our patient, but we have also to ask about possible barriers in our patients. So as we know, we can have different type of barriers in order to perform exercise. So we have to check for physiological barriers and physiological barriers are from a different type of limitation that we can understand, that we can measure via global assessment of functional capacity and also functional limitation. But we have also checked for individual barriers. the aim of our exercise prescription is also to bypass these barriers, is also to go through these barriers and individualize the way to overcome these barriers. So we have to know these barriers in order to overcome them. And often in people with obesity, we have some barriers that as doctors we are not so used to check. So people with obesity can have kinesiophobia because often they have osteoarticular problems. So the movement can induce pain, for example. So often they have fear of movement. So we have to understand how this fear can be a barrier for our patient and try to overcome this feeling. And then it’s true that often patients with obesity tend to be sedentary, but we also know that the movement is harder for people with obesity. We know that functional capacity is lower in people with obesity. So what seemed to others very easy, very light activity for people with obesity can represent a maximal effort or a higher effort than other people. So this is a solid barrier that we have to face, in example, by adapting the progression of our exercise prescription. And then we have to take into account what is the process of change of our patients. So what is the stage of the motivation of the patient? They don’t, maybe the patient don’t want to start with exercise. So we have to share with the patient how it’s important and what benefit it can achieve. And maybe the patient want to start, but he is unable to start. So we have to take into account this stage and advise patient and answer to his question. So we have to start from the patient to gain a true patient-centered approach. We have to start from the stage of change of the patient and build from this point, from the starting point, our exercise prescription. And again, we have to also take into account what are the external barrier for our patient. Often patient have no time to exercise or can’t afford the economic load of physical exercise. So we have to try to find strategies to overcome these barriers. And last but not least, we have to also be in the field of education and try to educate also trainer and kinesiologist and exercise professional in order to be aware, to have knowledge about obesity and how to manage people with obesity that want to start or continue in exercise programme. All these, facing all these barriers make exercise feasible and make our prescription applicable to the patient. Then the second A is assess. So first of all, we have to assess what is the physical fitness level of our patient. What does it mean physical fitness? The physical fitness is the body’s ability to function efficiently and to efficiently perform activity of daily living or different type of tasks of exercise and of exercises. So we have different domain of physical fitness. We have, first of all, the cardiorespiratory fitness can evaluate with cardiopulmonary exercise tests, but we have also muscle strength, balance and flexibility. All these domains contribute to the general, to the global physical fitness and all these domains may be impaired in people with obesity and all these domains may be addressed with specific exercise prescriptions. So we have to first of all evaluate all this domain and how we can do. So before to start in measuring aerobic capacity, we can start from the physical activity level evaluation. We have a simple questionnaire, but we can use also data from activity tracker and also more simply from diaries that we can advise to the patient in order to understand the level of physical activity. But then we can go through more sophisticated measure of physical fitness, of cardiorespiratory fitness via the cardiopulmonary exercise test that is the gold standard for the measurement of cardiorespiratory fitness and that give us many, many information also about the general health of the patient, also about the specific limitation of the patient. But if we can perform CPAT, we can use also more simple instruments such as sick-minute walking test, for example. Then we have also to check for other parameters. In patients with obesity, that can have also sarcopenic obesity. It’s very important to understand what is the strength level, what is the muscle mass, and the body composition in order to check for the presence of sarcopenia. And also for the other domains of function of physical performance, that is the flexibility and balance. and we can perform it also in a simple way with some tests or with the balance test. And then the assessment is also a clinical assessment. People with obesity have often a higher cardiovascular risk. So before to start exercise, in particular, if we want to do endurance exercise or high intensity exercise, we have to carefully check for cardiovascular screening in this patient. So, first of all, clinical examination and clinical history can give us important information about the clinical status of our patient. The resting ECG and the blood pressure measurement first line approach, but exercise, stress test and also CPAT can give us very important information, solid information, not only about cardiorespiratory fitness and the different functional limitations in our patients, but also about extensive cardiovascular screening. In example, about inducible ischemia, about exercise blood pressure. in patients with obesity, we have exaggerated blood pressure during exercise and by performing an exercise test, stress test, we can measure also blood pressure during exercise and we can check also eventually for arrhythmias. So, this incomplete evaluation that we can choose to to perform on the basis of the clinical condition on the first line clinical examination of our patient may give us a comprehensive status of the patient and may allow different exercise prescriptions. So going through our 5-A framework, framework, we can advise our exercise prescription. And the classical exercise prescription follows the FIT-B model. So we have to write down a precise exercise prescription, how we do for every other kind of medication. So we have to say the frequency in which the patient has to assume this exercise pill. important, it’s very important to set the intensity. The intensity of exercise is on the basis of the cardiovascular risk of the patient, so we know if the patient can or can’t do high intensity or endurance exercise and then on the basis of our goal. If we want to improve, through improve, cardiorespiratory fitness, as we said with the presentation of Professor O’Pear, we have to try to set the intensity in the endurance level, because the lower intensity is not so effective in improving cardiorespiratory fitness, in example. And we have also to set the time. So in order to understand, because the time that we spend in exercise combined with intensity is the volume of our exercise. And we know how much the volume count, the volume matters in order to achieve our goal in people with obesity. And then the type of exercise. So in the type of exercise, we know that each type of exercise can reach different goal. So we want to preserve lean masses, to increase muscle mass. We have necessary to prescribe resistance exercise and not only aerobic exercise. So we have to define our exercise prescription on the basis of the cardiovascular evaluation and on the goal that we want to gain. And last but not least, very, very important for people with obesity, in particular if the physical activity level is low at the beginning, it is important to think to the progression of the exercise prescription. So it’s okay to start slow, to start low in order to progress and progressively increase intensity and time spent in exercise, So progressively increase the global volume, the total volume of exercise. The progression is crucial for people with obesity and is crucial to understand, to have intermediate feedback, to set intermediate checkpoints, also to measure the intermediate results. So, the indication that the physical activity working group of IASO, in order to perform exercise prescriptions, are enclosed in this recommendation paper and, as you see, can allow the doctor to prescribe a different combination of exercises on the basis of the goal, on the basis of the cardiovascular evaluation and also on the basis of the preferences and the aim of the patient in order to be patient-centred in our prescription, but also to gain all the goals that we want to gain also beyond weight loss. And then an important A is the agree A. So we have to agree with the patient about smart goals, smart aims. What does it mean smart? So the goals must be specific, clear, must be, we have to be in agreement with our patient about the goal that we want to achieve. And the goal can be changed and also redefined during the progression of the exercise prescription during time, but the goal must be measurable and also achievable. If our aim are not achievable, it is very bad for the patient because if we give them a goal that is not achievable, the motivation can go down and also the compliance with our prescription may go down with bad consequences for the patient. And the goals must be also relevant for the patient and also be time bound with our prescriptions. So agree with the patient also the time frame in which we want to reach a specific goal. It is very crucial to assist the patient in this pathway and in order to overcome barriers, check and recheck during the follow-up what are the feedback of the patient about physical exercise and focus and address issues. don’t be scared to share issues with the patient, to find new strategies if some strategies did not work. And we have to individualise prescriptions also when the life of the patient changes and also if the relations with the exercise change during our exercise training programme. And yes, of course, we have to address comorbidities in our exercise prescription in order to have a comprehensive approach for our patient. And very, very crucial is also, we know that maybe most of us are doctors, so our job is to evaluate and prescribe, but we have also had in mind how to implement this pathway in our clinical settings. So this is what happened in our clinical setting in Padova, in our comms. It’s not, of course, the best way to proceed, but it’s our way to implement the exercise prescription in our multidisciplinary team in our com. So, as you can see, in our group, the doctor, the obesiologist, but also the surgeon, but also the dietitian and other specialists or GPs or psychologists, in example, can send the patient to exercise prescription or cardiopulmonary exercise test. So, the first multidisciplinary team decide on the basis of the clinical characteristic of the patient to start with the CPAT to the cardiopulmonary exercise test or directly with the exercise prescription. Then, in our sport and exercise division, we decide, in example, if the patient is sent to exercise prescription if performed cardiopulmonary exercise test on the basis of clinical characteristics of the patient. But sometimes the patient comes to us, some from other specialists, in example cardiologists or pneumologists. So the patient can come to us for heart failure, for COPD or other diseases, but we understand by doing our functional evaluation and our clinical evaluation that the patient can benefit from an integrated management of obesity if he has obesity. So sometimes we send the patient to the multidisciplinary team for the management of obesity. And then after our evaluation, It happens sometimes that we have to send, that we found some clinical problems, some cardiovascular problems, so we go to further clinical evaluation and after this further clinical evaluation, patient can come back to us for exercise prescription or go back to the multidisciplinary team to reframe the management of the obesity management. After receiving our exercise prescription, we plan also where the patient can perform his exercise. So, if the patient has a particular clinical problem or have particular needs about supervision and about evaluation during exercise, we can send the patient in our hospital gym that is a protected field, a protected gym where there is always a doctor, that we have some facilities to manage exercise training in a high-risk patient. And then after a first period in our hospital gym, we can send the patient in another gym, an example in health gym where there is a supervision of exercise. Or if the patient has a lower intensity, less clinical problems, we can send directly the patient in the health gym, in general gym, or we can decide with the patient to perform home exercise or other type of exercise. So on the basis of clinical evaluation and on the basis of the preferences of the patient, agree about the best solution for the individual patient to perform exercise. And very, very crucial is the role of kinesiologists that can supervise and administer exercise in this patient and that are very well-trained in people with chronic disease and with obesity. And also the kinesiologist is a very crucial figure because he can give feedback both to the com and also to the sports doctor or the prescriber of exercise in order to understand what are the possible adaptations that are needed for exercise. So in the end, I want only to say that physical exercise and obesity management is very utilized and sustain the benefit of weight loss, but in the other side can also counteract some side effect and also address some targeted outcomes. Some side effect of other strategies, in example, sarcopenia, and also address some untargeted outcomes in example for general quality of life and empowerment of the patient. It is very, the first goal for me when I prescribe exercise is the engagement of the patient, is the empowerment of the patient that feel that is first actor of this therapeutic pathway. So exercise is a very crucial point for the integrated treatment of obesity and address the need to reach global health and to overcome functional limitations and to improve quality of life and mental well-being. So I want to thank again Ieso and all for the attention and I’m very happy to hear about

Speaker 1 • 49:20
the questions. Thank you, Francesca and Frank, you are both speakers for excellent talks. We have a couple of questions and the first one is about in your bed bound clients, where do you start increasing their activity levels?

Speaker 2 • 49:51
So, if I may, this is a very, very important question, I think, and I’m sure Francesca has her views on this. So, here I think the issue is not even about physical activity, I mean, it’s just mobility. And I think this is really where physiotherapy has a great role. So first to increase mobility in bed, increase muscle strength in bed, and then help get out of the bed and walk and increase gradually mobility. So I think this is exactly where it starts as Francesca explained, this is a gradual process with increasing progressively physical activity and it starts there.

Speaker 1 • 50:54
– Thank you. And we have also a questions from Sherry Bryant. Very helpful talk, thank you. Thinking about our work within the comms, Can you share a specific barrier you have faced when embedding exercise into routine pathways as part of CAMHS care? And how do you overcome it?

Speaker 3 • 51:25
Yes. So, in example, one classical barrier is lack of time. not only for people with obesity, but for all people that want to start to exercise. And an example is a very simple example of patient-centered approach, but we don’t say to the patient when he has to find time. But the first question is, please look at your week and tell me when you can put it 15 minutes that you can spend in exercise. And then come back to me and then we start from your point. This is an example, a very common barrier, but the approach must be patient-centered. So we have to start from the patient needs. Or another important clue is about the money that the patient has to spend to pay kinesiologists and supervision and gyms or equipment and so on. So we start from the possibility of the patient and also a time and approach for supervision an example. And we plan, for example, a more intensive supervision at the beginning and then a lower supervision if the patient is more trained and more able to perform exercise. So I think that starting from the patient point of view, from the patient needs, instead that say what you have to do, what the guidelines say and so on, must be a practical and useful approach.

Speaker 1 • 53:26
So this is a very practical question. Which resistance exercises better? Resistance, balance, free weights or own body weights? bit short in the answers so we can reach to cover all the questions.

Speaker 3 • 53:49
So my opinion is difficult to say what is the best for all. But if we go to this particular aspects we have to individualize for the patient and for the needs of the patient. So, I don’t have the one size fits all in this case, but all type of resistance could be useful or all type could be hazard or not so useful, but it depends from what we want to reach and the type of patient. In my opinion.

Speaker 1 • 54:32
OK, do you want to add something Jean-Michel?

Speaker 2 • 54:36
No, I think the next question is very interesting.

Speaker 1 • 54:39
OK. Is it important to inform patients that weight loss is not necessary in order to improve their health?

Speaker 2 • 54:51
Yeah, so this is an important issue. I’m not sure I would phrase it this way. I think weight loss is important, but exercise should not be the preferred way to try to get weight loss. And then, of course, health improvement is another very important objective in obesity management, and there exercise can help a lot. So, of course, there are these many false hopes regarding physical activity and weight loss. So, it’s important to inform the patient about this. But, so, I would not be too negative about weight loss in itself, but it’s just that exercise should not be regarded as the way to improve weight loss.

Speaker 1 • 55:55
Okay, thank you. And so we have two questions here. What is the best tool to measure physical function in your opinion? And also in the community-based patients who can’t attend hospitals, what are critical physical observations or eczema examinations needed before starting to prescribe exercise?

Speaker 3 • 56:29
So, as I tried to say before, so for each domain of physical function, we have different type of tests and specific tests. So, of course, for aerobic capacities or cardiorespiratory fitness, the best way is cardiopulmonary exercise test if we have the possibility to perform this test. For strength, for general strength, also hand grip strength can be useful, but for more particular assessment of strength, we can use isokinetic machine and isokinetic test that can better describe also the lower limb, in example, the lower limb strength. Then we have specific tests to assess flexibility and specific tests to test balance. We have to embed the best practice,

Speaker 2 • 57:42
the best, the gold standard of measurement.

Speaker 3 • 57:44
also with the setting that we are in and try to understand the better combination that we can offer to the patient. But all this domain must be checked before to prescribe exercise individually and to perform a high-level exercise prescription, an highly individualized exercise prescription. And then for the second… In community dwelling patients.

Speaker 2 • 58:22
So I can try to answer this one in 30 seconds.

Speaker 1 • 58:25
Yes, very good.

Speaker 2 • 58:26
You need to know what the patient has been doing as physical activity in the past, what the patient is doing as physical activity currently, What are the comorbidities? What are the preferences? What are the barriers? We address that. What is available in the living environment of the patient? And then the most important thing is the follow up to re-evaluate the patient after this first advice. Thank you.

Speaker 1 • 59:01
Thank you to Francesca and Jean-Michel and everyone that attended this webinar. We are out of time and we have some more questions but that will those will be answered afterwards. So thank you again. I wish you a nice day and and hopefully we see each other in Istanbul. Thank you. Thank you Mette. Thank you very much. Bye-bye.