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Okay…in Part I of this series I talked about the categorization and staging of obesity and in Part II I dropped a few fundamental thoughts (and some great resources) for preparing to train clients with obesity.  If you haven’t read these I’d suggest you go back and read them first.

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Goals

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Today I want to move forward and actually get into details about how I train people with obesity.  More specifically, I want to focus today on how I train clients with Class 2 and Class 3 obesity (BMIs over 35 and 40 respectively), but first I just want to touch on the subject of goals.  I read somewhere recently that when those with the higher classes of obesity are asked to define their weight loss goals it is common for many to desire and expect weight losses of as much as 50% of their current body weight.  In other words, if you’ve got a 500 pound man, his goal might be to reach 250 pounds.  If you’ve got a 300 pound woman, her goal might be to reach 150 pounds.

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Frankly, I don’t have any studies to back up this assertion, but based on my experience I can only say that there is certainly some truth to this.  As a human, I can certainly understand how someone with class 3 obesity might just want to be “normal”.  However, as a fitness professional I feel it is my responsibility to temper this belief with a delicately put explanation of reality.  The very real truth is that weight loss will likely be much less.  Even with bariatric surgery (eg: gastric bypass) the average weight loss is around 20-30% so the likelihood of weight losses this great with non-surgical methods are not great.  That certainly isn’t to say that they can’t happen (I’ve seen it with a couple of my own clients), but I think it is more prudent to emphasize the medical benefits of weight losses as small as 5-10%.  In fact, even without a body weight change, the addition of exercise alone can improve health markers, mobility, and wellbeing.

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I think the key here is to not prevent clients from making these goals for themselves (good luck if you try to do that), but to stress the benefits of lesser weight losses and applaud them as they achieve them.  Further to this point, with these clients in particular I would generally focus less on the outcomes and have them focus heavily on weekly behavioral goals instead.  As it will take a long time to lose this much weight, clients will get more consistent feelings of accomplishment from achieving small goals instead of looking at the overall goal (which can be discouraging).

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It is important to remember that two of the biggest predictors of long term adherence to an exercise program are the reality of their expectations and self efficacy (belief that they can do it).  Expecting too much and falling short obviously makes us want to give up which is why I try to emphasize realistic goals.  And giving them small weekly steps increases the belief that they can achieve the activity required which only sets them up for success.  Of course, you can probably see how this could work for non-obese clients as well…which it does.

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Side Note

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I chose to distinguish the training of Class 2 and 3 obesity from Class 1 or even just people in the overweight category because I think that goal setting should be different and the programs could actually be different between these groups to some degree (depending on the level of impact their obesity has on their movement).  I’ll talk more about this in my next post, but for now, I’d suggest employing the goal setting practices above for higher BMI clients.   But now that we’ve got that taken care of, let’s get into the training.

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*Note that the training I’m discussing here is if I am personally working with a client.  This is NOT the same as I’d recommend to an unsupervised person with obesity trying to get started on their own.*

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Assessments

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As many of you know, I’m big on assessments with clients.  However, in dealing with obese clients whether or not I use a formal movement assessment depends on their ability to actually move in the first place.  If they’re relatively young and otherwise healthy (Stage o or Stage 1 obesity) I’ll do a movement assessment as usual.  If their movement is greatly impaired or their obesity is really impacting their ability to move (due to pain, being deconditioned, etc) I skip it.  Of course, I could modify my assessment, but generally I don’t.  Someone in this position has bigger issues than whether they can dorsiflex their foot to X number of degrees or any other measure when it comes to movement.  Some may disagree and choose to assess anyway…and that is up to them.  Personally, I don’t always do it as I figure I can do it later when they’ve established themselves in some good nutritional and exercise patterns that will address their bigger issues.

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However, with clients that are in this category of obesity I think it is important to make sure to have their physician involved with doing some baseline and follow up assessments as well.  Measuring fasting glucose, lipid profiles, and various other health markers is wise to ensure that what you’re doing is actually making them healthier AND it serves as yet another marker of progress for the client.  And from a business perspective, their physician might notice what you’re doing and refer you more people…just sayin’.

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More to the point though, the doctor can also assess for sleep apnea (which can be related to depression and lack of weight loss) and other obesity related issues.  Free bonus tip:  If your client has sleep apnea make sure they get the mask refitted as they lose weight as it can become ineffective.

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Foam Rolling

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As a general rule, if a client can do this, we’ll do it.  If they can’t get down to the floor and up again without a big struggle, we skip it.  I do believe it is important, but not important enough to humiliate a client.  As they’re able, we’ll add it in.  The Stick may be an option for those who can’t get down to the floor if it is absolutely necessary.

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For those who can get down to the roller, remember that they’ll be putting a lot more weight onto a focused spot on their body and it can hurt.  If this is their first encounter with fitness that might be discouraging.  For this reason, we have 3 different foam rollers of increasing density with one being quite soft, and a little harder, and being the normal foam roller most would use.  I’ve found this helps.  My buddy Nick Tumminello also once mentioned putting a couple rollers under the area being rolled to increase the surface area and decrease pressure to get the same effect.  Nick is smart!

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Mobility Work

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For those clients I’ve done a formal movement assessment on, I will normally design the mobility program based on that.  For those I haven’t assessed, I make an assumption based on educated guesses as to what is typically tight/weak/etc.  This may be a crappy approach, but in the end, I’m getting people moving.  For many, breaks will be needed between drills and for some the drills alone can actually be the exercise session.

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Early in my career I used to try to make sure the client achieved their “planned workout”, but these days I think it is more important to just “roll with the punches” and work within the limits the client has.  Push a little.  Gain a little progress.  Show them small successes.  Then STOP!  Don’t force it.  Just encourage them and keep them coming back for more.  This will do infinitely more for anyone than breaking them down with hard workouts that make them overly sore and sick.

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Resistance Training

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Here’s the thing – with obese clients in these categories muscle will be lost with weight loss.  You can work to prevent it, but ultimately, it is going to go down.

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Here’s the other thing – many of these clients will have never worked out in their lives.  For most, it has at least been a long time.  Which ultimately means, it doesn’t really matter what you do (unless you do something completely idiotic) because they are going to get results (i.e., some muscle retention, strength, etc).

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I generally start these clients with 1-3 sets of 10-15 repetitions on 5-6 exercises in a whole body workout 2-3 times per week.  So on their first day (and for each workout for a few weeks) I might do 1 set of 10-15 on each of 6 exercises.  Over time I’ll bump it up to two sets.  And finally up to 3 sets.  Then I’ll probably move towards pairing antagonist exercises (like a row and a bench press), but keeping the same set/rep scheme.  Over time I may substitute in new exercises, but keep everything else the same.  In short, I keep it wicked simple.  My goal is to create CONSISTENCY as I think this is the most important factor for these folks.

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With increasing length of training time, strength, mobility, and weight loss their programs will start to look increasingly like my “normal” training programs, but at the start (and by start I mean first 3, 6, or even 9 months) their programs are pretty basic.

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Cardio

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While interval training may be faster and debatably “better” than steady state cardio (although I’m hard pressed to believe the second statement), I think it is probably the worst choice for a novice obese client.  I’ll often have them do as little as 10 minutes of moderate intensity cardio after a session and aim for a couple of extra walks (5-30 minutes depending on mobility, etc) during the week.  Ultimately, I tend to see walking as the gateway drug of fitness and while it isn’t necessarily the best exercise for weight loss, there are some remarkable health outcomes that can be brought about by walking alone.

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Over time I’ll increase the time (for the person who can only walk short distances) and intensity of cardiovascular activity for these clients.  Eventually I might include some more interval type protocols in the interest of time, but this would be far down the line and subject to client tolerance and interest in this type of training.  But the big thing you’ll notice in these programs is that resistance training is only typically 2 days per week (3 days max) and that my goal is to build up to 150-200 minutes of weekly physical activity by adding increasing amounts of cardiovascular activity (which can be as simple as walking).  Keep in mind that going from zero minutes of physical activity to 200 can take a LONG time…so patience is key and it is important to focus on the aforementioned small weekly steps forward.  Encouragement is paramount!

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Summary

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And that’s about it.  Pretty simple really.  I’m sure I’ve overgeneralized here as there are definitely cases where obese clients have done much less than this (only walking) and others have done much more.  Looking back, I’m not really happy with the article as I feel there are many more qualifiers and exceptions I should have included, but this would easily end up being a novel.

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In my next post I’ll discuss the differences between training those in these categories of obesity and class 1 obesity, and the following post will cover a discussion of nutrition for both groups.

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In the meantime, if you have a specific question related to this post, please ask in the comments section below and I’ll be happy to address it.

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Check out Part IV of this series HERE.

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If this article has helped you or you think it might help others please share it via Facebook, Twitter, or whatever social media you like or simply hit the “like” button below.

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In my previous post I wrote a little bit about the categorization of obesity in terms of classes (weight) and the staging of obesity (health measures) that I use to help me training clients with excess weight.

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Today I had planned to get started on describing the methods I use to train those with varying degrees of obesity when it struck me that a lot of fitness professionals don’t truly understand obesity and, as a result, are misguided in their attempts to help people lose weight.  Most certainly, people are eating more and moving less, but unless we understand WHY people are consuming more and failing to move it will be darn near impossible to address these issues.  Today, my goal is to share with you some of my thoughts and provide you with some resources so that you can begin to understand the root causes of obesity.  By understanding these you can put in place practices to address them and have incredible results with these clients.

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If you’re going to train people with obesity, you should understand it.

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As I mentioned above, by understanding the determinants of obesity you can work towards addressing them and by doing this your results with this population (remember that many people who think they need to “lose a few pounds” are clinically obese).  In fact, I’ve mentioned before that addressing these issues need not even be a burden for a fitness professional, but an opportunity to make more revenue and differentiate themselves in a very competitive market.

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Here I am going to provide a few great resources on obesity.  Many who read this won’t take the time to check them out, but those who do will be rewarded with an incredible amount of understanding of this complex problem and I can guarantee it will be eye opening.  When I first started formally working with this population I thought I had all the answers…and I certainly didn’t.  So trust me when I say that the time you take to do this will be worth your while.

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Here is what I would do:

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Go to the blogs of Dr. Arya Sharma and Dr. Yoni Freedhoff and sign up for updates via email, RSS, Facebook, Twitter, or whatever.  Read them as they come.  Get smart.  And, perhaps more importantly, you can go to the Canadian Obesity Network website and download their book Best Weight for FREE.  All you have to do is sign up for a membership (which is also free) and you can get your mitts on a copy.  Although it is more geared towards physicians treating obesity, it will definitely provide insight on how to manage those with obesity and barriers to weight loss including medications, sleep apnea, and tons of stuff you probably hadn’t even thought about.

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I would also suggest taking the time to watch the video HERE by Dr. Robert Ross on the Cardiac and Metabolic Benefits of Exercise.  Dr. Ross is a great speaker and he makes some great points in this presentation.

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Recognize that obesity is a chronic condition

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Obesity, much like hypertension (high blood pressure) is a life sentence.  In other words, once you have it, you’ve got it for life.  But also like hypertension, when it is managed appropriately through activity, diet, and lifestyle changes it can essentially be controlled to a point where the person no longer meets the criteria to be defined as obese.  However, just as with any chronic condition, if you stop the treatment (i.e., stop exercising and increase intake) the condition returns full force.

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So even if a person loses weight, eats well, exercises regularly, and has a seemingly stable new lifestyle pattern, it IS still a chronic condition and remission is possible (and actually likely).  In fact, MOST people who lose weight will gain it back (some suggest the number is as high as 95%) which is why my focus weight clients is NOT on weight loss per se, but on the behaviors and habits associated with those results.

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Frankly, I’m not impressed if someone reports that they’ve lost 50 pounds in 12 weeks with program X as I’m almost positive that most programs have failed to address the reasons why the person became overweight in the first place and the results will be temporary.  This is why I think it is important to a) make clients aware of the chronic nature of weight management, b) don’t offer or promote programs that deliberately contradict this statement, and c) don’t let clients bully me into helping them lose weight quickly on the promise of transitioning to a more sustainable program later.

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Appreciate that PERMANENT weight loss is a slower and more behavior oriented practice.  And that practice must be forever as the condition most certainly is as well.

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Eliminate Your Bias

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Imagine going to get professional help with something and the person who was supposed to help you (i.e., the person who SHOULD be in the best position to help you) had an inappropriate preconceived notion that you were unintelligent just because you worked in a gym?  And what if their help towards you was based on this assumption?  What if they treated you like you were unintelligent?  How much help would they be to you?

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Taking this back to obesity, what if you (the person who SHOULD be in a position to help) were uneducated about obesity and had assumptions and biases that were actually AGAINST the person you were supposed to help?  How much help would YOU be?

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As a whole, I think that the fitness profession (who should be the ones equipped to make a difference with weight management) are probably the worst off when it comes to biases and stereotypes against obese folks.  In fact, we are so busy reading about the latest and greatest fat loss workouts or diets that we fail to educate ourselves on the ACTUAL causes of obesity (note: it has nothing to do with the fact that they didn’t properly time their post-workout shake with 20 grams of whey, 6 grams of BCAAs, creatine, and waxy maise).  So, if we want to be a force for ending this epidemic, we need to understand it…and rid ourselves of our biases.

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The first step to this is to identify your biases and then you can proceed to address them.  I wrote a post about a tool you can use to do this HERE.

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So that’s it for today.  Bookmark this if you need to, but make sure to take advantage of those resources because they are the foundation upon which my methods for training obese people are built.  Next time I’ll get into the actual practices of training obese clients.

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Check out Part III of the series HERE.

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Drop me a comment below and let me know what you think!  If you’re in the fitness industry and think your colleagues could benefit from reading this please don’t hesistate to share it.

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Notice I selected a picture of an obese person that didn't involve inaccurate stereotypes of them eating crappy food or being lazy.

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Over the past year or so a few fitness professionals (many of whom I respect) have written blog posts on how to train people with obesity.  As someone who is very familiar with this area, I figured I’d chime in with my own thoughts to add to the discussion and information about training this specific population for those who are interested in my take on the subject.

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As some of my readers know, I do some work for one of the very few government funded bariatric medical programs in my province providing evidence based (i.e., research backed) treatment for patients with obesity.  In our clinic we see hundreds of patients per year with weights ranging from 250 to 700 pounds.  My main role is to oversee the design and implementation of the exercise component of the program to get everyone exercising regardless of their physical, emotional, psychological, and economic limitations.  Combining that with my ongoing experience in the private sector in training people for fat loss (both online and in person), I feel that I’m in a good place to share my views on the topic.

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Definitions, Categorization, Etc.

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Before we can really talk about obesity though, we’ll need to clear up some definitions and lay down a foundation of understanding about how it is categorized.

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In short, obesity is defined and categorized primarily based on something called the Body Mass Index (BMI) which is essentially a height-weight scale.  In a publication in the early 1970′s it  scale was created as a proxy to determine body fatness in relation to height and weight, but more recent evidence suggests that this isn’t exactly true.  I’ll get into that in a bit, but for now you should know that BMI is the most widely used tool for the categorization of obesity in a medical setting.

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If you want to determine your BMI you can go HERE and use the calculator to let you know where you’re at.

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Categorization Based on BMI

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Under 18.5  -  Underweight

18.5 – 25  – Normal Weight

25 – 30  -  Overweight

30 – 35  -  Class I Obesity

35 – 40  -  Class II Obesity

Over 40  -  Class III Obesity

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Although this is the accepted World Health Organization categorization for obesity, it is pretty arbitrary and the divisions between most of the categories have no scientific explanation.  And since their are regional differences in “normal” body weights,  some places have different categorizations for obesity.  For example, the Japanese categorize anyone with a BMI of 23 as overweight and anyone with a BMI of 25 as obese.

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Of course, any astute fitness minded person will also note that BMI is limited in that it is not able to determine actual muscle and fat weight so someone who works out regularly and has a higher muscle mass might be categorized as obese while actually being quite lean.  In fact, the reverse can actually true as well which means that people with a “normal” body weight might actually carry an excess amount of body fat.  These are the people that we might call ”skinny-fat”, but are clinically defined as having normal weight obesity.

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Although I’m not sure this is universally agreed upon, having a body fat above 20% for males and 30% for females would make you obese regardless of your BMI.  And all of this leaves out the fact that where that fat is distributed may have an effect on cardiac health (i.e., fat around the waist = bad, fat around the hips = good) so you may be in danger regardless of whether or not you actually have a lot of fat.

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The Staging System

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So thus far we’ve talked about categorization of obesity based on weight and to some degree we’ve talked about body fat percentage without mentioning the methods used to measure body fat which is a different post entirely (Short version: Your home bathroom scale that measures body fat probably sucks).  However, to train people with obesity it is important not to just know how much they weigh, but the degree to which obesity is actually impacting their health, movement, etc.  To determine this it is helpful to determine the “stage” of obesity using something called the Edmonton Obesity Staging System (EOSS).  While I could type it all out for you, I’ll just swipe it from the site of Dr. Arya Sharma who is one of the creators of the system.

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STAGE 0: Patient has no apparent obesity-related risk factors (e.g., blood pressure, serum lipids, fasting glucose, etc. within normal range), no physical symptoms, no psychopathology, no functional limitations and/or impairment of well being.

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STAGE 1: Patient has obesity-related subclinical risk factor(s) (e.g., borderline hypertension, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of well being.

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STAGE 2: Patient has established obesity-related chronic disease(s) (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate limitations in activities of daily living and/or well being.

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STAGE 3: Patient has established end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitation(s) and/or impairment of well being.

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STAGE 4: Patient has severe (potentially end-stage) disability/ies from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitation(s) and/or severe impairment of well being.

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Looking at the list above, you might discover that as a client you have a person who is actually has Class III obesity, but is a stage zero and has no related health or mobility problems.  This could be a guy who was a lineman on his college football team, maybe he’s actually still fairly active, and he’s not sick.  This guy might thrive with hard training and a slowly integrated nutritional program.

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Training this guy might be different than working with someone with class I obesity that is a stage 3 and has disabling arthritis making it difficult to move let alone hit up some heavy squats.  This person would obviously require a drastically different program which is why I get worried when I see generalized recommendations for training obese folks.

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And if YOU are an “offseason” bodybuilder or you just train regularly and don’t have a solid nutrition program you might have gotten off easy before with the old mantra that “BMI doesn’t take into account my muscle mass so I’m not really obese”, but now you know that if your body fat is breaking 20% (or 30% for women) you ARE obese.  And you might actually be a class 1 or 2 on the staging system too.  You know that heartburn you’ve been getting and the slightly elevated blood pressure that you’re not paying attention to?  Those are potentially obesity related issues.

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So if you wonder why I spend so much time talking about obesity on my blog it isn’t because I’m talking about someone who is vastly overweight.  In my experience, most people who see themselves as having “only a few extra pounds” are actually clinically obese…and this includes those who exercise regularly and even fitness professionals themselves (we are not immune).

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Now that we’ve covered the basics and some definitions, in my next couple posts I’ll come back and drop some information about how I would go about training someone with different classes and stages of obesity.

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Check out Part II of the series HERE.

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PS:  If this post helped you or you think it would benefit others please share it.

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PPS:  Please feel free to join me on Facebook and Twitter.

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A couple weeks back I wrote a post in the benefits of writing action plans to implement small behavior changes to bring about long term results.  Frankly, I think that this is the best way to overcome stumbling blocks in getting started with an exercise or nutrition program for the beginner and for reaching new levels of achievement for advanced trainees.

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As a result of that post, I’ve had a few questions and I figured that today would be as good a day as any to one of them.

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Question: If I successfully implemented a behavior last week, do I have to change it or increase it this week?

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Answer: Definitely not.  If last week you decided you were going to exercise 3 times for 30 minutes and you achieved that goal, there is no reason to expect that this week you should attempt to do 4 days per week or increase the time to 45 minutes.  However, the aim of an action plan is to make regular small steps forward in ANY behavior the leads you towards your goal.  So this week you could very well maintain your previous exercise goal and address another behavior instead.

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For example, if your long term goal is weight loss and last week you began exercising as was discussed above, perhaps this week you can begin to address another simple habit like sleep as this can also effect weight management.  If you regularly go to bed late and get up early for work you might set an action plan to go to bed by 9:30 at least one night this week and build on that in later action plans.

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Ultimately, the when thinking about action planning it helps to take a look at what the ideal situation would look like for you to achieve your goal.  For fat loss you’d likely be exercising a few times per week, lifting weights, eating less junk food, maintaining a moderate calorie deficit, eating plenty of veggies and fruit, consuming adequate protein, drinking mostly water and few calorie containing beverages, sleeping 7-8 hours per night, and so on.  Doing all that at once is easily a recipe for failure (which is why most people that try this do not actually succeed in the long term), but breaking it down into very small managable actions will make it possible to implement this over a very long time line and make it more likely that you’ll be able to maintain it.

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So you select the easiest possible remaining behavior that needs to be changed and start working on it in the simplest possible way for you whether it be only one meal per week or one day per week.  Over time, new habits will form and the results will come.  They key is patience and consistency.  If you can accept that it will take time, the wait will pay off and you’ll eventually leave all those trying more severe programs in the dust as they struggle to maintain their new habits and eventually regain the weight they lost.

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And for those who are more advanced, the same thing appliles.  You may have already implemented behaviors that have set you on the path to your goals.  The key now is to identify which ones still lie between you and your intended outcome, pick the easiest one to change…and get after it.

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In the end, it is nice to read this stuff, but unless you’re actually doing it, you might as well have not wasted your time.   What is your action plan this week?  If I get enough people sharing theirs I’ll share my own next week.

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PS: If this post has helped you or you think it might be helpful to someone you know, please don’t hesitate to share it.

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Those who follow me on Facebook will know that I frequently signify the completion of each of my workouts with a status that simply says “Dose”.   I do this largely to share the message with others that exercise, all by itself, is simply one of the most powerful tools we have for the prevention and treatment of many disorders, dysfunctions, and diseases.  I want them to know that Exercise is Medicine!

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More importantly, my hope is that by sharing when I’ve had my “dose”  this will incite others (even if it is just ONE person) to move that day and begin to make a difference in their own lives and the lives around them.

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Now, if I’m being honest, the phrase above isn’t my own. “Exercise is Medicine” is actually the name of an initiative coordinated by the American College of Sports Medicine and I have borrowed it because it is such a powerful statement and I think it speaks to a lot of people.  Because of this, I want to use today’s post to touch briefly on the medicinal (and almost magical) benefits of exercise.  More specifically, I want to focus on the improvements that can be had with exercise EVEN IF WE DON’T RESTRICT CALORIES.

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1. Improved Cholesterol

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Exercise alone has been shown to increase HDL (good) cholesterol, which is a valuable improvement for heart health.  And while some might argue that cholesterol is largely related to genetic factors and another faction might even argue that improving cholesterol isn’t linked to many “hard” outcomes (like improving mortality rates), I feel it is still worthy of attention and it is formally considered a risk factor for cardiac issues is most medical establishments.

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2. Decreased Triglycerides

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Triglycerides, in the simplest sense, are the fats that float around in our bloodstream and when they become elevated can put us at increased risk for heart disease. Exercise can burn off these fats and it has been shown (in many cases) to be even better than calorie restriction for this very purpose.

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3. Decreased Blood Pressure

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High blood pressure (otherwise known as hypertension) is a leading cause of strokes and it is often called “the silent killer” because you don’t necessarily notice the change happening as it slowly increases over time. Exercise can reduce both systolic (the top number) and diastolic (the bottom number) blood pressure thereby reducing our risk of stroke.

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4. Improved Insulin Sensitivity

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When we eat a carbohydrate (vegetables, fruits, starches, and candy) the sugars from those foods goes into our blood stream. Our pancreas then releases the hormone insulin to tell many of the cells in our body to take up and use those sugars. *Note to fitness peeps – Don’t crucify me here, I’m simplifying for the masses*

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When our cells become insulin resistant they fail to listen to the signals given by insulin (kinda like I do to my wife when she asks me to take the garbage out) and the sugars in the blood continue to rise. Left unchecked, this problem can become worse and eventually may lead to diseases like Type 2 Diabetes which can bring with it a whole host of other problems like vision loss, neuropathy, and kidney problems.

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The most incredible thing though, is that as soon as you begin to move your body shuttles the sugars from your blood into your cells for use, blood sugar normalizes, and your sensitivity to insulin jumps up drastically. In fact, this jump is so drastic that if you want to show the effects of exercise on chronic changes in insulin sensitivity (not just those from the most recent exercise bout) you have to wait FOUR DAYS to test for this. So the result is INSTANT and lasting.  The second you move…you improve!!!

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Add to that the fact that over time insulin sensitivity will become improved even while you’re not exercising if you continue to maintain that active lifestyle!!!  Whether you’re currently healthy, insulin resistant, or Diabetic exercise can help.

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5. Reduced Waist Circumference and Visceral Fat

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You’ve probably heard that certain body shapes are more at risk for cardiovascular issues and that is probably an understatement. While there is some research suggesting this is not the case, most professionals would agree that fat stored around the waist (more specifically around the organs – called visceral fat) is a ticking time bomb.

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Fortunately, exercise can decrease abdominal fat and waist circumference EVEN WITHOUT WEIGHT LOSS. I’ve seen cases where people are losing 8-10 inches off their waists in 6 months with no change in weight so not only does it look better, but they have drastically reduced their risk of death from cardiovascular causes.  So you can get new jeans and be healthier!  Score one for activity!

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6. Improved (or maintained) Bone Density

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As women get older – or for those who have had their ovaries removed – the risk for bone loss increases leading to hip fractures, immobility, and other complications increases. Simple higher impact activities or moderate resistance training can prevent bone loss and even increase it if you work hard enough.

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7.  Increased Strength

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I could go on all day about the virtues of being strong, but in terms of every day activites, it just makes life easier.  From picking up groceries and children, to lifting stuff at the gym getting strong is like a magic pill that helps make things that were once difficult feel simple.  Exercise can make you stronger and THAT is medicine.

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8. Stress Reduction

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Whether this is brought about by neurochemical changes in the brain or some psychological factor I don’t know.  Frankly, I don’t even really care.  To me, lifting heavy things helps to vent my frustrations through the iron.  But at the same time, going for an afternoon in the park with my wife and daugher, running on the climbers, and swinging on the swings does exactly the same thing for relaxing my mind and bringing me in touch with what is REALLY important in life.

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9. Increased Muscle Mass

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As muscle mass is corrlated with strength, metabolism, and absolute sexiness (okay…I made up the last one…but I figure it helps with that too) you can’t go wrong by getting active.  You’ll be stronger, leaner, and sexier for your efforts.  In fact, those who lose weight without activity tend to lose muscle mass, reduce their metabolic rate, and have a harder time overcoming plateaus.  So whether you’re dieting or not…movement is good.

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10. Weight Loss

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I’ve said in the past that I don’t think adding exercise to an already solid diet does a lot in terms of absolute amount of weight lost.  In that case, I think it comes down to more of what kind of weight is lost.  With activity involved, a greater proportion of the weight lost will be fat and more muscle will be retained so exercise obviously has a role here.

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But even without calorie restriction, moderate intensity exercise can bring about a weight loss if the appropriate amount of activity is done.  Below 150 minutes per week you’d be looking at 9lbs in a year, over 150 minutes per week and you’ll achieve closer to 18lbs in a year, and once you exceed 200 minutes per week (about 30 minutes per day) you can score yourself about 33lbs of weight loss in one year with NO DIETARY CHANGE!!!  Of course, changing your diet is good too, but in terms of health you could lose weight and become more active and you’d be reducing TWO risk factors for heart disease!

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Frankly, I could probably go on forever and talk about the effects of cardiovascular fitness on reducing mortality and so forth, but I think you already get the idea.  My two most major points are that exercise is NOT just about weight loss (although it helps) and that regardless of how much you’re willing to do, the benefits are incredible as long as you start.

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Even if it sounds like a HUGE leap for you…take small steps as I suggested HERE.  Plan week by week and set achievable action plans.  The medicine and the magic of exercise will pay off.  And when it does…you’ll feel awesome!  So walk, run, swim, dance, or lift.  It doesn’t matter.

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Exercise is medicine!  Just move and get your dose!

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*Note – I realize that I’m probably preaching to the choir here (or at least a lot of you) so please share this with those who need to hear it via Facebook, Twitter, email, or whatever method you can.*

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