Bulldog Weight Loss The Role of Water Aerobics in Weight Management

By Isabella Storyclaire

last updated November 18, 2024

Contributions sourced from

8 Best Water Aerobics & Activities for Weight Loss [2024]

Exercising underwater makes perfect sense if you think about it. On dry land, we have two enemies that are always present: gravity and the weight of our own body. Think about it some more and its obvious we cant do anything about these. Short of taking out membership of the gym on a space station, gravity is always going to be with us, keeping our feet on the ground. As regards weight, we can always shed a few pounds, but were still made out of flesh, blood and bone, so thats natural downward pressure. Do it underwater, though, and the picture changes dramatically. Its called low-impact pool exercise. With our natural ability to float, when we are in the water, we have to make a conscious effort to touch the floor. The water makes everything gentler, cushioning and protecting us. Perhaps the main question about all this is: it is clearly a good idea, so why havent we been doing it all along?

What Do Our Water Aerobics Workouts Consist of?

At APT, our water aerobics workout involves the use of your whole body so that you get the maximum benefit from attending the program. It will help to improve your cardiovascular health, as well as your core and balance. You can look forward to having dramatic results from your time with us, as long as you commit to your program 100%. You can read through some of our testimonials to hear more about what our clients think about training with us and the results they have achieved.

Your pool workouts are designed to keep your interest peaked and to keep challenging you throughout. Programs are regularly adapted and changed so that classes are always exciting.

If you are looking for a water workouts class, then the APT aqua physical classes are perfect for you. Our programs typically run for 45 minutes, and this gives you enough time to get a great workout.

Many of our water aerobic classes contain exercises with weights to help you get the most from your session. Unlike other centers who may use pool noodles and foam dumbbells, which only have little effect on your body, here at APT, we use unique strength training equipment. These are designed to improve strength, flexibility, and cardiovascular endurance. We also have water aerobics for seniors at the center to cater the elderly.

This is very important because if we stop exercising because were not as fit as we used to be, its a double whammy. An ageing body needs support to enable it to exercise the parts that not suffering and need to be maintained, so water aerobics for seniors is the obvious answer.

As well as our unique strength training equipment, we also use aquatic bikes and treadmills within our programs and personal training sessions. By using this equipment in the water, you are protecting your body from common injuries that can occur when completing land-based exercises.

We know this looks funny and your friends are going to raise an eyebrow when you tell them about it, but youll be talking as one who knows something they dont. Youll be the new fitness guru of your group.

You can choose to complete your aquatic workouts in a large group training program or through a one-to-one personal training session. Our personal training is suitable for anyone, but it is particularly good for those who have suffered from injuries, are recovering from surgery, or want to lose a lot of weight. During our personal training sessions, you will have the maximum attention, and we can make sure all exercises are completed correctly so that you get the maximum benefits, as well as being fully accountable.

If these technical terms sound a bit remote and scientific, its probably because you dont see your body as the many-splendored machine that it is. Once you start looking at it that way, youll be better able to look after it as you should. A whole-body workout makes a lot of sense too. Go for a run and youre using only cardio to get healthy and missing out on strength and flexibility. Get the rest of your body involved, as you do when swimming, and youre getting 2x or maybe 3x benefit.

No matter which type of program you choose to partake in, you can look forward to our highly educated and qualified instructors. Our instructors are trained to take you through low impact pool exercises in the water, so your health is in the best hands. Read Less

The Importance of Sleep in Weight Management: American Hospital Associations Perspective

Getting sleep is crucial for maintaining overall health and well being. It not helps in rejuvenating our bodies and minds but also has a significant impact on various aspects of our daily lives, including weight management. In this article we will delve into the connection between sleep and weight management from the perspective of the American Hospital Association (AHA).

Understanding the Relationship between Sleep and Weight Management

Sleeps Influence on Hormones

Having an amount of sleep has a profound effect on regulating hormones, particularly those associated with appetite and feeling full. When we dont get sleep these hormone levels can be disrupted, leading to increased hunger and reduced feelings of satiety. The AHA emphasizes the importance of maintaining a healthy sleep routine to ensure hormone functioning.

Sleep Deprivation and its Impact on Appetite

Lack of sleep is often linked to an increased appetite especially for high calorie, sugary or fatty foods. The AHA highlights that individuals who are deprived of sleep tend to make food choices and consume larger portions, which contributes to weight gain. This connection between sleep and heightened appetite underscores why prioritizing quality sleep is essential, for effective weight management.

Sleep quality and metabolism

The quality of sleep is not about how long you sleep but also how well you sleep. It turns out that poor sleep quality can have an impact on your metabolism disrupting the bodys energy regulation and potentially causing weight gain or making it harder to lose weight.

The role of sleep in dietary choices

Emotional Eating and Sleeping

Another important aspect is the connection between sleep and our dietary choices. When were stressed, anxious or experiencing emotions its common to turn to food for comfort. The American Heart Association (AHA) highlights that poor sleep can contribute to instability increasing the likelihood of emotional eating. By prioritizing good quality sleep we can better manage our emotions. Reduce the urge to rely on food as a coping mechanism.

Sleep and food cravings

Furthermore lack of sleep can lead to strong cravings for unhealthy and high calorie foods. The AHA recommends that by ensuring we get restful sleep we can better regulate these cravings and make healthier choices when it comes to food. Improving our sleep quality can help us control those food cravings and maintain a more balanced and nutritious diet crucial elements, for effective weight management.

Sleep, exercise and weight loss

Sleep and performance during activity

Regular physical activity is crucial for managing weight and sleep plays a vital role in optimizing performance during exercise. The American Heart Association (AHA) highlights that getting quality sleep enhances focus, alertness and coordination enabling individuals to exercise effectively and enjoyably. By ensuring sleep individuals can enhance their exercise routines and achieve their weight loss goals more efficiently.

Sleep and recovery of muscles

During sleep the body undergoes repair processes, including muscle recovery and growth. The AHA emphasizes that lack of sleep can disrupt these processes impacting muscle recovery and overall physical performance. Adequate sleep allows the body to repair and rebuild muscles effectively maximizing the benefits of activity for weight management.

Tips for improving sleep to support weight management

To enhance sleep quality while supporting efforts for weight management the AHA suggests the following tips:

Establishing a bedtime routine

Maintaining a regular bedtime routine helps regulate the bodys internal clock and promotes better sleep. Going to bed and waking up at times every day. Even, on weekends. Helps establish a healthy pattern of sleeping.

Creating a sleeping environment

The sleeping environment significantly influences the quality of our restful slumber.The AHA suggests that maintaining a dark and quiet bedroom can help promote better sleep. It is also beneficial to limit exposure to devices before bedtime in order to improve the quality of sleep.

Managing stress and anxiety

Managing stress and anxiety is crucial for maintaining sleep patterns. The AHA recommends incorporating stress management techniques like relaxation exercises, meditation or engaging in calming activities before going to bed. By reducing stress levels individuals can enhance the quality of their sleep. Support their weight management goals.

Conclusion

In conclusion getting sleep is vital for managing weight effectively. The American Hospital Association emphasizes that sufficient duration and quality of sleep play a role in regulating hormones, controlling appetite boosting metabolism influencing dietary choices improving exercise performance and overall well being. Prioritizing quality and restful sleep is essential, for those aiming to achieve and sustain a healthy weight.

Frequently Asked Questions

How many hours of sleep should I aim for each night?The American Hospital Association recommends adults aim for 7-9 hours of sleep per night to support overall health and weight management.
Can lack of sleep cause weight gain?Yes, inadequate sleep can disrupt hormone regulation, leading to increased appetite and a higher likelihood of weight gain.
Does sleeping more help with weight loss?While quality sleep is important for weight management, its not a direct solution for weight loss. However, sufficient sleep can support overall health and improve various factors related to weight management, such as appetite control and exercise performance.
What are some natural remedies for improving sleep quality?Establishing a sleep routine, creating a restful environment, and managing stress and anxiety are all natural remedies that can help improve sleep quality.
Are there any foods that can promote better sleep?Certain foods, such as those containing tryptophan (found in turkey, nuts, and seeds) or magnesium (found in leafy greens and nuts), can potentially promote better sleep. However, individual responses to specific foods may vary, so its essential to pay attention to personal preferences and dietary needs.

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.

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

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]

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]

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]

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]

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]

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]

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]

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]