Variability in adherence to an unsupervised exercise prescription in obese women

Abstract

Objective: To measure adherence to a specific exercise prescription (1500 kcal week À1 ) by objectively quantifying unsupervised exercise energy expenditure (ExEE) in obese women. Design: The 16-week lifestyle intervention consisted of weekly meetings with research staff and promotion of increased ExEE (1500 kcal week À1 ) and a decreased dietary intake (À500 kcal day À1 ). Participants: Twenty-nine obese females (body mass index ¼ 36.8 ± 5.0 kg m À2 , body fat ¼ 49.6 ± 3.7%) from a hospital-based lifestyle intervention were included in the analysis. Measurements: ExEE was estimated and monitored weekly using heart rate monitoring, and body composition was measured before and after the intervention by dual-energy X-ray absorptiometry. Results: Free-living adherence to the exercise prescription was variable and, on average, modest such that 14% achieved 1500 kcal week À1 , and the average weekly ExEE (768 kcal week À1 ) represented 51.2% of the total amount prescribed. ExEE was correlated with changes in body weight (r ¼ 0.65, Po0.001) and fat mass (r ¼ 0.65, Po0.001). Achievement of a 5% weight loss target was dependent on the achievement of an ExEE level of 1000 kcal week À1 (Po0.001). Exercise 'adherers' (41000 kcal week À1 ) lost more weight (À9.9 vs À4.1 kg), more fat mass (À6.8 vs À3.0 kg) and more waist circumference (À9.8 vs À5.6 cm) when compared to 'non-adherers' (o1000 kcal week À1 ). Discussion: Exercise is an integral component of lifestyle interventions aimed at reducing obesity and its complications. However, without accurate and objective measures of ExEE, it is difficult for relationships between exercise and health outcomes to be elucidated. The present study suggests an alternative to self-report to increase the confidence with which conclusions are drawn regarding the role of exercise within lifestyle interventions.

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“…Such methods are effective to reinforce adherence, but it was assumed that there was a danger of increasing the burden on caregivers by adding too much mental stress originally [8,9,13]. Furthermore, another study has reported that adherence to an unsupervised exercise regimen in obese women was poor [25]. However, supervision of female caregivers is a practical difficulty.…”

Does metabolic compensation explain the majority of less-than-expected weight loss in obese adults during a short-term severe diet and exercise intervention?

“…Body composition was determined by dual energy X-ray absorptiometry (Lunar DPX, Lunar, Madison, WI) 23 and from measurements of total body water using the stable, nonradioactive, non-toxic isotope deuterium ( 2 H 2 O), as previously published. 24 Resting metabolic rate RMR was measured using a ventilated hood system (Deltatrac II, Datex, Helsinki, Finland) calibrated before each measurement with standardised gases.…”

Behavioral Compensatory Adjustments to Exercise Training in Overweight Women

“…This suggests that studies investigating exercise-induced compensatory mechanisms should focus on individual variability rather than consider body fat or body weight changes in the group as a whole. In addition, such studies should ensure adherence to prescription of exercise since variability in the effectiveness of exercise in relation to body fat loss could be accounted for difference in compliance (8,10).…”