Which is Better for Promoting Weight Loss?

Activity BEFORE eating?     Activity AFTER eating?

 

For those taking insulin or medications that stimulate extra insulin production, exercising after meals allows for dosage reductions without the need to consume extra carbohydrate.  Since lowering insulin doses facilitates the breakdown of the body’s fat stores, this helps promote weight loss more than before-meal exercise, which requires extra food intake.

 

Obesity

Obesity has become an epidemic in most industrialized countries.  In the United States, it is estimated that nearly half the adult population is overweight, and almost half of those are considered obese.  Modern society features far too many labor-saving devices.  Eliminating physical activity from our daily routines cuts down dramatically on caloric expenditure for the average person.  This makes it more important than ever to build physical activity into our daily routine.

 

Providing the patient with an exercise prescription can help to improve outcomes. An exercise prescription is nothing more than a detailed, customized set of recommendations on how to exercise safely and effectively.

 

Study:

Effectiveness of Physical Activity Advice and Prescription by Physicians in Primary Care

Grandes, et al. Arch Intern Med 2009; 169(7): 694-701

Research supports the importance of providing more than just the usual “you should get more exercise” rhetoric for our patients.  Grandes studied the effects of providing detailed exercise prescriptions for patients in a randomized, controlled, blinded, multi-center trial.

 

The group receiving “usual care” received literature about exercise and was provided with general recommendations to increase physical activity.  The experimental group also worked on goal setting and overcoming barriers to exercise, and was provided with a workout log and written, customized exercise prescription that included the recommended mode, frequency, duration, intensity and progression of exercise activity. 

 

Control Group	Advice-Only Group	Advice + Prescription Group
•Provider Training •Standard Care	•Provider Training •Used Web software re: benefits, risks, general activity suggestions •Summary pamphlet	•Same as advice group, + •Goal setting •Barriers addressed •3-month Plan •Printed exercise Rx (mode, freq., duration, intensity, progression) •Self-monitoring log
N=2069 MDs=27	N=1565 MDs=29	N=683 MDs=29

 

After 6 months, the “usual advice” group showed little change in moderate-to-vigorous activity level compared to a control group which received no advice at all. However, the group that received a detailed exercise prescription more than doubled its weekly exercise energy expenditure. 

 

6-Month Outcomes

Incr. in moderate / vigorous activity (min/wk) Incr. In moderate / vigorous activity (MET h/wk) Control 31.3 2.05 Advice Only 36.4 2.41 Advice + Prescription 79.7 5.49