'This is a journey': Proper exercise 'dosing' for weight maintenance

Key takeaways:

• Properly “dosing” exercise to patients can be a critical part of weight management and keeping patients engaged in the process.
• It is important to meet patients where they are, a presenter said.

NATIONAL HARBOR, Md. — The proper “dosage” of exercise can be one of the most important components in weight management, according to a presenter at the Obesity Medicine Association’s annual conference.

WHO’s 2020 exercise guidelines recommend that adults complete 150 to 300 minutes of moderate physical activity per week — or 75 to 150 minutes of vigorous intensity per week — along with muscle-strengthening activities 2 days per week.

But in his presentation, John M. Jakicic, PhD, a professor at the University of Kansas Medical Center, said researchers are now “finding evidence of a dose response” related to exercise, and these guidelines may not be exactly right for everyone.

For example, among people with a very sedentary lifestyle, “going from nothing to something is really important. It may not move their body weight 1 ounce, but it’s going to start to move their health a little bit,” he said.

“Obviously, we want to progress up to 150 minutes a week. But you know what? For some health outcomes, even though it’s not a maximal effect, we can get good effects with 60 minutes a week, or 30 minutes a week, or 90 minutes a week,” he added.

For that reason, Jakicic said providers should not immediately tell patients to shoot for 150 minutes per week.

“Let's get them doing something. If I could get a patient to do 10 more minutes of activity a day to start, guess what? I’m at 70 minutes already. I’m almost halfway there,” Jakicic said. “But I don’t start talking about 150 minutes. I start talking about, ‘how can I get you to do more?’ This is a journey.”

When finding the right exercise dosage for their patients, providers should consider three major components: workout frequency, length and intensity.

For frequency, Jakicic recommends his patients stay active most days of the week, if not all.

“We want to get them to think about activity and engage in activity just like they do with the medications that you prescribe for them,” he said. “If they have a blood pressure medication, don’t they take that daily?

“The dentist does not tell people to brush their teeth three times a week,” he continued. “There are some health behaviors that we try to do every day, even if it’s a little bit. For it to become a habit, we want people moving every day.”

Length and intensity will vary from patient to patient, Jakicic said. Every minute that a person moves matters, but benefits increase with 10-minute bouts of intense exercise.

Jakicic also warned against the extremes, like overdoing it and treating patients like athletes. He said studies have shown 150 minutes of exercise per week offered sufficient weight loss and maintenance benefits in thousands of patients.

“Not everybody needs to progress in 200 to 300 minutes a week,” he said. “We progress them there if they need to go there, but they don’t have to go there — just like you don’t change a dose of a medication unless you have to.”

Similarly, he said patients often have the misconception that, as they exercise more, more weight will come off. But that in isolation will not do much and may even counteract their goals if they are living in a super hypocaloric state — or, taking in extremely few calories.

“When you add exercise to extreme levels of caloric restriction, the effect of that exercise on body weight and body composition is minimized,” Jakicic said. “Sometimes you basically attack the system out. You start to restrict so much that the further effect that exercise and activity will have on reducing body weight further, or changing body composition further, is very, very, very limited if the calorie intake is not sufficient.”