Role of Physical Activity in Obesity Treatment and Cardiometabolic Health: A Scientific Statement From the American Heart Association.

Obesity rates have reached all-time highs, with obesity affecting 42% of adults in the United States. In addition, obesity is strongly associated with numerous cardiovascular disease (CVD) risk factors such as hypertension, dyslipidemia, and insulin resistance. Thus, treatment strategies aimed at promoting obesity-related weight loss (WL) and reducing CVD risk are a prominent focus in health care. Physical activity (PA; any bodily movement produced by skeletal muscles resulting in energy expenditure) is a key component of these strategies, playing a major role in WL, WL maintenance (WLM), CVD risk reduction, and overall health promotion. This scientific statement aims (1) to provide an overview of the cardiometabolic health benefits and role of PA in comprehensive obesity treatment approaches, complementing lifestyle, pharmacological, and surgical-based WL intervention strategies, and (2) to provide potential behavioral strategies that can be considered in efforts to enhance PA in patients with overweight or obesity. provides a practical framework for integrating PA across the WL and WLM continuum, illustrating the distinct phases and corresponding PA considerations discussed throughout this scientific statement. Before we discuss the relationship of PA with WL and WLM, it is important to emphasize that PA and exercise (a planned, structured, and repetitive subset of PA performed to maintain or improve health, fitness, or both) have cardiometabolic health benefits independently of WL. The Physical Activity Guidelines for Americans recommend that adults engage in at least 150 to 300 minutes of moderate-intensity aerobic PA or 75 to 150 minutes of vigorous-intensity PA per week for significant health benefits. In addition, muscle-strengthening activities of moderate or greater intensity involving major muscle groups should be performed ≥2 d/wk. For those initiating PA, it is important to note that health benefits can be obtained by adopting modest amounts of PA (ie, below the recommendations); some health benefits, including reduced blood pressure and increased insulin sensitivity, can be observed even after a single episode of moderate to vigorous PA on the day of the activity. PA and exercise programs are well established for improving major cardiometabolic risk factors (eg, hypertension, insulin resistance, and dyslipidemia), which are highly prevalent in patients with overweight or obesity. Aerobic exercise reduces resting blood pressure (Δsystolic, −4 mm Hg; Δdiastolic, ≈−3 mm Hg) in the general popualtion. Specifically in adults with overweight or obesity, a meta-analysis of 54 randomized controlled trials (RCTs) of PA and exercise, which encompassed aerobic, resistance, or combinations of the 2 training modalities with program durations ranging from 4 to 48 weeks, showed that exercise training improved resting blood pressure in the total sample (Δsystolic, −3.0 mm Hg; Δdiastolic, −1.9 mm Hg) and in a subset of participants with hypertension (Δsystolic, −3.4 mm Hg; Δdiastolic, −2.1 mm Hg). Exercise training also decreased insulin resistance (Δhomeostatic model assessment for insulin resistance, −0.34) with a more pronounced effect in a subanalysis, specifically in adults with type 2 diabetes (Δhomeostatic model assessment for insulin resistance, −0.50).