Beagle Weight Loss The Role of Inactivity in Weight Gain

How Can I Help Beagle Lose Weight? 4 Expert Tips

Beagles are adorable dogs with friendly and curious personalities. They are also known for their amazing sense of smell, which makes them excellent hunters and trackers. However, this trait can also lead them to overeat and gain weight, especially if they are not given enough exercise and stimulation. Many people ask me how to help beagle lose weight, so in this article, I will discuss some signs that your beagle may be overweight, some common causes of obesity in beagles, and some tips to help your beagle lose weight and stay fit.

Obesity is a serious health problem for dogs, as it can cause many complications such as joint pain, diabetes, heart disease, and reduced lifespan. Therefore, it is important to help your beagle maintain a healthy weight and prevent obesity.

How to Tell If Your Beagle Is Overweight

It can be hard to tell if your beagle is overweight, as they naturally have a round and chubby appearance. However, there are some ways to check if your beagle is carrying too much fat and needs to lose some pounds.

One way is to use a body condition score chart, which is a tool that helps you assess your beagles body shape and fat distribution. You can find a body condition score chart for dogshere.

According to the chart, a healthy beagle should have:

• A visible waist when viewed from above
• A tucked-up belly when viewed from the side
• Ribs, spine, and hip bones that are easily felt but not seen
• A thin layer of fat covering the body

If your beagle does not meet these criteria, he or she may be overweight or obese. Another way to tell if your beagle is overweight is to weigh him or her regularly and compare the weight to the ideal weight range for beagles.

The ideal weight range for beagles depends on their height, which can be measured from the floor to the top of the shoulder blades.Beagles that are 13 inches or less should weigh less than 20 pounds, while beagles that are 13 to 15 inches should weigh between 20 and 30 pounds.

If your beagles weight is above the ideal range, he or she may need to lose some weight. However, before you start any weight loss program for your beagle, you should consult your veterinarian to rule out any medical conditions that may cause weight gain and to determine the best diet and exercise plan for your beagle.

What Causes Obesity in Beagles?

There are many factors that can contribute to obesity in beagles, but the main cause is usually an imbalance between energy intake and energy expenditure. In other words, your beagle eats more calories than he or she burns.

Some of the reasons why your beagle may eat more calories than he or she needs are:

• Overfeeding: Beagles have a strong appetite and a tendency to beg for food, which can make it hard to resist giving them extra treats or portions. However, overfeeding can lead to weight gain and obesity, as your beagle may consume more calories than he or she can use.
• Lack of exercise: Beagles are active and energetic dogs that need regular exercise to stay healthy and happy. However, if your beagle does not get enough physical activity, he or she may not burn enough calories and may store the excess as fat. Lack of exercise can also lead to boredom and stress, which can make your beagle eat more to cope.
• Age: As beagles get older, their metabolism slows down and their activity level decreases, which means they need fewer calories to maintain their weight. However, if you do not adjust your beagles diet and exercise accordingly, he or she may gain weight as he or she ages.
• Neutering or spaying: Neutering or spaying your beagle can have many benefits, such as preventing unwanted pregnancies, reducing the risk of certain cancers, and improving behavior. However, it can also affect your beagles hormone levels and appetite, which can make him or her more prone to weight gain. Therefore, you may need to reduce your beagles calorie intake and increase his or her exercise after neutering or spaying.
• Medical conditions: Some medical conditions can cause weight gain in beagles, such as hypothyroidism, Cushings disease, or diabetes. These conditions can affect your beagles metabolism, hormone levels, or blood sugar, which can make him or her eat more or burn fewer calories. If you suspect your beagle has a medical condition that causes weight gain, you should consult your veterinarian for diagnosis and treatment.

How to Help Beagle Lose Weight

If your beagle is overweight or obese, you should help him or her lose weight to improve his or her health and quality of life. However, you should not put your beagle on a crash diet or a drastic exercise regimen, as this can be harmful and ineffective. Instead, you should follow these tips to help your beagle lose weight safely and gradually:

• Cut back on their food: The first step to help your beagle lose weight is to reduce his or her calorie intake. You can do this by feeding your beagle smaller portions, using a measuring cup or a scale to measure the food, and following the feeding guidelines on the dog food label. You can also switch to a low-calorie or weight-management dog food that is specially formulated for overweight dogs. However, you should not cut your beagles food too much, as this can cause nutritional deficiencies and health problems.You should aim to reduce your beagles food by 10 to 20 percent, depending on his or her weight and activity level.
• Increase exercise: The second step to help your beagle lose weight is to increase his or her physical activity. Exercise can help your beagle burn calories, build muscle, improve mood, and prevent boredom. You can increase your beagles exercise by taking him or her for longer or more frequent walks, playing fetch, tug-of-war, or other games, or even enrolling him or her in a dog sport or agility class.You should aim to exercise your beagle for at least 30 minutes a day, or more if possible.
• Talk to your veterinarian: The third step to help your beagle lose weight is to consult your veterinarian. Your veterinarian can help you determine your beagles ideal weight, body condition score, and calorie needs. He or she can also recommend the best type and amount of food for your beagle, monitor your beagles weight loss progress, and adjust the diet and exercise plan as needed. Your veterinarian can also check your beagle for any medical conditions that may affect his or her weight and treat them accordingly.
• Be patient: The fourth and final step to help your beagle lose weight is to be patient and consistent. Weight loss in dogs is a slow and steady process that requires time and commitment.You should not expect your beagle to lose weight overnight, or to lose more than one to two percent of his or her body weight per week. You should also not give up or get discouraged if your beagle does not lose weight as fast as you hoped, or if he or she plateaus or gains some weight back. You should stick to the diet and exercise plan, reward your beagle with praise and affection instead of food, and celebrate every small achievement.

How do I keep my Beagle skinny?

In addition to cutting down on calorie intake, boosting physical activity plays a crucial role in aiding a Beagles weight loss. Failure to include exercise in a weight loss regimen can significantly delay observable results. Moreover, consistent physical activity is essential for overall well-being and has the potential to extend a Beagles lifespan.

Why is my Beagle getting fat?

Similar to Retrievers and Spaniels bred for work, Beagles also possess a hearty appetite. Once again, this inclination might be attributed to human-driven breeding practices, where dogs motivated by food were preferred for training purposes. This preference has resulted in the Beagle breed being naturally predisposed to greediness and a higher likelihood of overeating.

Why is my Beagle not losing weight?

Every dog is unique, and if your canine companion is not shedding pounds on the prescribed diet, it could indicate a slower calorie burn rate. The daily food allowance might exceed your dogs energy requirements, necessitating further reduction. Before seeking guidance from your vet, ensure that everyone in the household is adhering to the designated diet plan.

Final Thoughts of Help Beagle Lose Weight

Beagles are wonderful dogs that can bring joy and fun to your life. However, they can also become overweight or obese if they eat too much and exercise too little, which can harm their health and happiness. Therefore, it is important to help your beagle maintain a healthy weight and prevent obesity.

By following the tips in this article, you can help beagle lose weight safely and gradually, and improve his or her well-being. Remember to consult your veterinarian before starting any weight loss program for your beagle, and to monitor your beagles weight and body condition regularly. With your love and support, your beagle can achieve his or her weight loss goals and enjoy a longer and happier life with you.

Role of Physical Activity for Weight Loss and Weight Maintenance

Diabetes Spectr. 2017 Aug; 30(3): 157160.

Role of Physical Activity for Weight Loss and Weight Maintenance

Providence Medical Group/Endocrinology, Diabetes and Nutrition, Missoula, MT

Corresponding author.

Copyright

2017 by the American Diabetes Association.

Abstract

IN BRIEF This article reviews the impact of exercise on weight loss and weight maintenance and the possible reasons that weight loss outcomes resulting from exercise are not consistently realized.

Energy balance is a process through which the body attempts to establish homeostasis. Most individuals spend much of their lives in the same weight range without daily focus on caloric intake and output. The two parts of the equation for weight maintenance are energy intake (eating and drinking) versus energy output (nonexercise thermogenesis + exercise). To achieve weight loss, the American Diabetes Association (ADA) (1), American Academy of Clinical Endocrinologists (AACE) (2), and National Academy of Nutrition and Dietetics (3) all recommend exercise as an integral part of any weight loss program. Physical activity and exercise are often used interchangeably. However, correctly defined, physical activity is all movement that creates energy expenditure, whereas exercise is planned, structured physical activity (1).

Research supports the importance of exercise in relationship to improved cardiovascular fitness, insulin sensitivity, glycemic control of type 2 diabetes, blood pressure, and depression scores (1), but does exercise itself contribute to weight loss and maintenance efforts?

The questions addressed in this article are: Does exercise in and of itself improve weight loss efforts outside of dietary restriction? Is there a difference between aerobic training and resistance training in achieving weight loss or weight maintenance? What are the potential explanations for less weight loss than predicted with exercise? When weight loss is achieved through any weight loss intervention program, does exercise contribute to the maintenance of that weight loss?

Does Exercise in and of Itself Improve Weight Loss Efforts?

Many outcomes data have been reported from research studies that have examined exercise alone, exercise plus dietary restriction, or dietary restriction alone to determine strategies for weight loss. The challenge over time is to accurately monitor both sides of the equation as individuals interact in their daily lives.

A systematic review of studies with a minimum of 1-year follow-up (4) suggested that subjects who used exercise alone for weight reduction experienced minimal weight loss. There are two questions that need clarification: 1) Does the drive for homeostasis require greater bouts of exercise than previously recommended to contribute to weight loss? 2) Do individuals compensate for exercise by either eating more or reducing their nonexercise activity thermogenesis?

Thirty-six overweight participants were assigned to either exercise plus calorie restriction or calorie restriction alone to determine whether exercise enhanced weight loss efforts. The calorie deficit remained constant during the 6-month trial. Ten percent weight loss was achieved over 6 months in both interventions without a statistically significant difference in the percentage loss of body fat. However, the exercise group had the added benefit of improved aerobic fitness (5).

In a randomized, controlled trial of 52 obese men (BMI 31.3 2.0 kg/m²), Ross et al. (6) demonstrated a body weight decrease of 7.5 kg over 3 months in the exercise-only group (16 men) that was comparable to that of the calorie-restricted group. Duration of exercise was based on the goal of a daily 700-calorie energy expenditure (60 min/day), suggesting that performing exercise greater than the minimum national recommendations for health of 150 min/week may be required to achieve clinically meaningful weight loss.

Donnelly et al. (7) demonstrated weight loss with exercise alone in a group of 141 overweight or obese (BMI 31 kg/m²) men and women in the Midwest Exercise Trial 2. Exercise was supervised for 10 months with an exercise calorie-equivalent reduction of either 400 or 600 calories 5 days per week and a completion rate of 65%. In the completion group, weight losses were 3.9 4.9 and 5.2 5.6 kg, respectively. This demonstrated a clinically significant weight loss for both men and women. However, the amount of activity to achieve this weight loss was again greater than the general exercise recommendations for health.

Weiss et al. (8) demonstrated not only effective weight loss (7% over 16.8 weeks) with exercise alone, but also preservation of lean body mass (LBM) and improvement of maximal oxygen consumption (VO_2max) when compared to weight loss with a comparable energy deficit through calorie restriction alone; the latter resulted in both a loss of LBM and a decrease in VO_2max. In addition, as with other studies that have demonstrated weight loss with exercise, the amount of exercise was substantial at 7.4 0.5 hours/week.

Longer bouts of exercise have demonstrated a greater contribution to weight loss, both in controlled research trials and through self-reported information collected by the National Weight Control Registry (NWCR) (911). The NWCR has reported that 94% of individuals in the registry reported including exercise in their weight loss program (9); weight loss was greater in the group with the greatest physical activity, but this group also reported more dietary restraint (10), and only 1% of participants reported exercise alone for weight loss (11).

Most, but not all, study data indicate that exercise alone plays a very small role in weight loss. A joint position statement of the American College of Sports Medicine and the ADA (12) states that the recommended levels of PA [physical activity] may help produce weight loss. However, up to 60 min/day may be required when relying on exercise alone for weight loss.

The 2016 AACE and the AmericanCollege of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity (13) include an evidence recommendation for aerobic training of 150 min/week of moderate intensity, with better outcomes with increasing amounts and intensity of exercise.

Is There a Difference Between Aerobic Training and Resistance Training or the Intensity of Activity in Achieving Weight Loss or Weight Maintenance?

Willis et al. (14) compared aerobic exercise (calorie equivalent to 12 miles/week), resistance exercise (3 days/week), and a combination of the two to determine changes in body mass with a consistent program of exercise and without alternations in reported energy intake in a group of individuals who were previously sedentary and without diabetes (BMI 2535 kg/m²). Weight loss and fat mass reduction occurred with aerobic training to a more significant degree than with resistance training after the 8-month trial (1.76 vs. 0.83 kg for the aerobic and resistance groups, respectively). Adding resistance training did not enhance the change in total body mass compared to aerobic training alone. Over the 8-month study period, there was minimum weight change, suggesting the need for greater energy expenditure to contribute to major weight loss.

Exercise regimens of varying intensities and durations were added to a calorie- and fat-restricted food plan in a randomized, controlled trial by Jakicic et al. (15). Although not statistically significant, an absolute difference in weight loss of 1.7 kg was achieved with more vigorous and higher-duration exercise at 12 months.

What Are Potential Explanations for Less Weight Loss Than Predicted From Exercise?

The amount of weight loss predicted based on calculated energy expenditure often does not reflect the actual weight lost during research trials. Possible explanations include physiological compensation (less nonexercise activity) and limited control of food intake day by day for the duration of the trial, with the potential for compensatory food intake.

Thomas et al. (16) suggested in their review of 15 studies that the small amount of weight loss observed is the result of a combination of the low level of prescribed exercise and a subsequent increase in calorie intake.

A recent meta-analysis of 51 trials (17) suggested that in the short term, energy intake does not compensate for energy expenditure. Two to 14 hours after exercise bouts of 30120 min at 3681% VO_2max, the difference in absolute energy intake between exercise and control groups was small; however, a reduction in relative energy intake of >119 calories was noted in 25 of 29 studies within the 51 trials.

Blundell et al. (18) suggested a considerable individual variability with regard to exercise and appetite/food intake. Influences on intake include fat and fat-free mass, resting metabolic rate, and hormonal responses, which vary from person to person, making the individual response to exercise and weight loss difficult to predict.

The article by Caudwell et al. (19) is in agreement with this assessment. These researchers developed an approach to assessing adaptive regulatory biological systems to determine the impact of physical activity on appetite and its contribution in turn to the impact on weight. There appeared to be a large difference in individual responses to physical activity. Neither nonexercise activity nor resting metabolic rate changed significantly. Nonresponders to weight loss strategies demonstrated a much greater degree of hunger and subsequent food intake, which was sufficient in quantity to explain the weight differences.

Research findings suggest that there are responders and nonresponders to exercise as a weight loss tool. Energy intake compensation over the long term may partly explain this variability.

When Weight Loss Is Achieved, Does Exercise Contribute to the Maintenance of That Weight Loss?

Physical activity may be an important component of weight maintenance after weight loss. An excellent study that measured total energy expenditure with the doubly labeled water method suggested that physical activity in the range of 1112 kcal/kg/day (900 calories/day for an 81-kg woman) may be important to prevent weight regain (20). In the NWCR, 90% of participants reported exercise to achieve long-term weight loss maintenance, with an average 383-calorieenergy expenditure 7 days/week (21). In addition, a systematic review of the literature by Fogelholm and Kukkonen-Harjula (22) suggested that an increase in energy expenditure of 1,5002,000 calories/week is associated with weight maintenance. In a 33-year follow-up study, men who maintained activity >150 min/weekgained 5.6 kg compared to 9.1 kg in less active men, with an even more significant trend (3.8 vs. 9.5 kg) among women (23).

Tate et al. (24) reported that, in a 30-month study of 202 overweight adults, those whose exercise expenditure was >2,500 calories/week had less than half the weight regain of those whose exercise expenditure was <2,500 calories/week (2.9 vs. >6 kg).

There is also evidence to support the notion that individuals who are less physically active are more likely to gain weight over time than those who exercise between 150 and 300 min/week (25).

Recent research based on the NWCR showed that both high- and low-exercise groups were able to maintain weight loss for 3 years. This suggests that there is a great deal of variability in individual responses to the ability to maintain weight loss over time (10).

Strategies to Promote Physical Activity in Practice

Although exercise contributes to multiple health benefits, and most of the research suggests that it can play a role in both short- and long-term weight loss and weight maintenance, patients often have a difficult time engaging in a regular exercise program and continuing that program as a lifestyle modification. Thirty-six percent of people >18 years of age with diabetes reported no physical activity in the previous 30 days (26). Only 30% of patients are counseled about exercise during an appointment with their primary care physician (27). Starting with the first encounter, physicians and other health professionals should engage patients in a discussion of the importance of daily exercise, which may promote weight loss in overweight people, but also reduce weight gain over time, contributing to overall health.

A recent article addressing strategies for promoting physical activity in clinical practice (28) provided excellent suggestions for engaging patients in physical activity. These include lifestyle modification suggestions such as getting up out of a chair and walking for 2 min every 3060 min, connecting patients with physical activity professionals to create individualized programs that work for them, using mobile technology applications, and creating a Walk with a Doc program in the local community.

Conclusion

The evidence that exercise contributes significantly to weight loss and weight maintenance is not firmly established. It is important to recognize the challenge of monitoring dietary intake and exercise intensity and duration over the long term. Overreporting of actual exercise and underreporting of food intake by individuals could be a contributing factor to the mixed results found to date. In addition, individual differences may play a role (responders vs. nonresponders). Variability in sex, BMI, exercise intensity and duration, and type of exercise in research studies make conclusive recommendations more difficult. Minimal research has been focused specifically on the weight loss effects of exercise alone in individuals with type 2 diabetes, who may have a different response to exercise than the population without diabetes.

Consistently performing exercise of a duration greater than the basic recommendations for health (150 min/week of moderate-intensity exercise) does appear to be more likely to contribute to weight loss and weight maintenance efforts over the long term.

Physical activity of all types, including aerobic, resistance, flexibility exercises, and reduced sedentary time clearly results in multiple health benefits for individuals with type 2 diabetes and should be included in any lifestyle recommendations for individuals with diabetes (1). Encouraging individuals to exercise for longer periods of time each day may help to enhance weight loss. However, it is challenging for some patients to consistently achieve even small bouts of exercise daily. In counseling patients, it is important not to focus on the potential for weight loss as the sole outcome from exercise, but rather to suggest that exercise may contribute to weight loss efforts and does result in a myriad of other health-related benefits. This focus will reduce the likelihood of patients using the lack of weight loss as a reason to discontinue their exercise program.

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

References

1.

Colberg SR, Sigal RJ, Yardley JE, et al.. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care2016;39:20652079 [PMC free article] [PubMed] [Google Scholar]

2.

Handelman Y, Bloomgarden Z, Grunberger G, et al.. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for developing a diabetes mellitus comprehensive care plan2015. Endocr Pract2015;21(Suppl. 1):187 [PMC free article] [PubMed] [Google Scholar]

3.

Seagle HM, Strain GW, Makris A, Reeves RS; American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Diet Assoc2009;109:330346 [PubMed] [Google Scholar]

4.

Franz MJ, VanWormer JJ, Crain L et al.. Weight-loss outcomes: a systematic review and Meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc2007;107:17551767 [PubMed] [Google Scholar]

5.

Redman L, Heilbronn L, Martin C, et al.. Effects of calorie restriction with or without exercise on body composition and fat distribution. J Clin Endorcrinol Metab2007;92:865872 [PMC free article] [PubMed] [Google Scholar]

6.

Ross R, Dagnon D, Jones P, et al.. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. Ann Intern Med2000;133:92103 [PubMed] [Google Scholar]

7.

Donnelly JE, Honas JJ, Smith BK, et al.. Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial 2. Obesity2013;21:E219E228 [PMC free article] [PubMed] [Google Scholar]

8.

Weiss E, Jordan R, Frese E, et al.. Effects of weight loss and lean mass, strength, bone and aerobic capacity. Med Sci Sports Exerc2017;49:206217 [PMC free article] [PubMed] [Google Scholar]

10.

Ogden L, Phelan S, Thomas J, Hill J, Wing R, Wyatt H. Dietary habits and weight maintenance success in high vs low exercisers in the National Weight Control Registry. J Phys Act Health2014;11:15401548 [PMC free article] [PubMed] [Google Scholar]

11.

Wing R, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr2005;82(Suppl.):222S225S [PubMed] [Google Scholar]

12.

Colberg SR, Sigal RJ, Fernhall B, et al.. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association joint position statement. Diabetes Care2010;33:e147e167 [PMC free article] [PubMed] [Google Scholar]

13.

Garvey WT, Mechanick JI, Brett EM, et al.. AACE/ACE comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract2016;22(Suppl. 3):1203 [PubMed] [Google Scholar]

14.

Willis L, Slentz C, Bateman L, et al.. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol2012;113:18311837 [PMC free article] [PubMed] [Google Scholar]

15.

Jakicic J, Marcus B, Gallagher K, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight sedentary women. JAMA2003;290:13231330 [PubMed] [Google Scholar]

16.

Thomas DM, Bouchard C, Church T, et al.. Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obes Rev2012;13:835847 [PMC free article] [PubMed] [Google Scholar]

17.

Schubert MM, Desbrow B, Sabapathy S, Leveritt M. Acute exercise and subsequent energy intake: a meta-analysis. Appetite2013;63:92104 [PubMed] [Google Scholar]

18.

Blundell JE, Gibbons C, Caudwell P, Finlayson G, Hopkins M. Appetite control and energy balance: impact of exercise. Obes Rev2015;16(Suppl. 1):6776 [PubMed] [Google Scholar]

19.

Caudwell P, Gibbons C, Hopkins M, et al.. The influence of physical activity on appetite control: an experimental system to understand the relationship between exercise-induced energy expenditure and energy intake. Proc Nutr Soc2011;70:171180 [PubMed] [Google Scholar]

20.

Schoeller D, Shay K, Kushner R. How much physical activity is needed to minimize weight gain in previously obese women?Am J Clin Nutr1997;66:551556 [PubMed] [Google Scholar]

21.

Klem M, Wing R, McGuire M, et al.. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr1997;66:239246 [PubMed] [Google Scholar]

22.

Fogelholm M, Kukkonen-Harjula K. Does physical activity prevent weight gain: a systematic review. Obes Rev2000;1:95111 [PubMed] [Google Scholar]

23.

Moholdt T, Wisloff U, Lydersen S, Nauman J. Current physical activity guidelines for health are insufficient to mitigate long-term weight gain: more data in the fitness versus fatness debate (the HUNT study, Norway). Br J Sports Med2014;48:14891496 [PubMed] [Google Scholar]

24.

Tate D, Jeffery R, Sherwood N, Wing R. Long-term weight losses associated with prescription of higher physical activity goals: are higher levels of physical activity protective against weight regain?Am J Clin Nutr2007;85:954959 [PubMed] [Google Scholar]

25.

Swift D, Johannsen N, Lavie C, Earnest C, Church T. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis2014;56:441447 [PMC free article] [PubMed] [Google Scholar]

26.

Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System Age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes who were physically inactive, United States, 19942010 [Internet]. Available from https://www.cdc.gov/diabetes/statistics/comp/fig9.htm. Accessed 30 December 2016

27.

Barnes PM, Schoenborn CA. Trends in adults receiving a recommendation or other physical activity from a physician or other health professional (NCHS Data Brief 2012:86) [Internet]. Available from https://www.cdc.gov/nchs/data/databriefs/db86.pdf. Accessed 29 December 2016 [PubMed]

28.

Sallis R, Franklin B, Joy L, Ross R, Sabgir D, Stone J. Strategies for promoting physical activity in clinical practice. Prog Cardiovasc Dis2015;57:375386 [PubMed] [Google Scholar]