The role of exercise in the treatment of obesity.

The prevalence of obesity in the USA has increased dramatically in the past decade. This foreshadows an increase in the rates of morbidity and mortality from obesity-related diseases and increases in the number of individuals undergoing weight-loss therapy. Although exercise has long been recommended for inclusion in such therapy, the present review has found that it has had little or no effect on weight loss per se when the exercise is limited to the typically prescribed 3-5 h/wk of moderate or vigorous activity. However, further review has shown that exercise helps to preserve and at times even increase fat-free mass during weight loss. At the same time, fat loss is generally increased. Neither type nor amount of exercise appears to have much effect during treatment, with the possible exception of resistance training, which is associated with the best outcome for fat-free mass. The most important role of exercise, however, is in the maintenance of the weight loss. In this respect, the volume of exercise seems to be important because several lines of evidence have indicated that exercise must expend roughly 2500 kcal/wk to maintain weight loss. Studies of weight maintenance, however, have generally not included randomized controls; thus, further research is required to solidify these conclusions.