‘Fat but Fit’ Paradox – Unravelling the Truth

Introduction

Obesity is now recognized as a serious chronic disease; in my post titled Is obesity a disease or a risk factor for other conditions? I had discussed the magnitude of obesity and why obesity is associated with so much ill-health. However, there are no easy solutions to obesity and managing your body weight is challenging at the best of times. In my post titled Weight Loss Maintenance After Weight Loss, I had discussed how over the long term, the vast majority of individuals regain the weight they have lost and that this relapse has a strong physiological basis and is not simply the result of the voluntary resumption of old habits. Some evidence suggests, however, that a high cardiorespiratory fitness (CRF) might mitigate the detrimental effects of excess body weight on cardiometabolic health, termed the ‘fat but fit’ paradox.

Recognition of the ‘fat but fit’ paradox

In my post, Complications of obesity: the mother of all diseases, I had discussed the various health complications associated with obesity.  However, accumulating evidence over the years suggests that being physically fit might attenuate some of the deleterious health consequences of obesity independently of some key potential confounders. About 3 decades ago, a study titled ‘Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women’ published in the Journal of the American Medical Association in Nov 1989, brought into focus the detrimental role of fitness (cardiorespiratory fitness [CRF]) vis-à-vis fatness on health, specifically all-cause mortality and CVD-related mortality. This longitudinal study followed up 10,224 men and 3120 women for slightly more than 8 years. The study found that better CRF, as measured by a maximal exercise test, was associated with decreased all-cause mortality in both sexes. Based on the maximal treadmill test, participants were stratified into quintiles of fitness categories. Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10,000 person-years in the least-fit men to 18.6 per 10,000 person-years in the most-fit men (fat but fit). Corresponding values for women were 39.5 per 10,000 person-years to 8.5 per 10,000 person-years. Lower mortality rates in higher fitness categories also were seen for cardiovascular disease and cancer of combined sites. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.

A couple with obesity exercising together, i.e. fat but fit.
A couple with obesity exercising together – ‘fat but fit’.
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Weight Training Program Design for Optimum Health.

Introduction

For most people, the term ‘exercise’ means aerobic activities like walking, jogging etc. The benefits of weight training (also commonly known as strength training or resistance training; the terms will be used interchangeably) are either overlooked or at best minimized to that of building muscles and improving sports performance. However, we now have a better understanding of the health-related benefits of strength training; the health benefits of enhancing muscular fitness are on par with aerobic fitness, if not more. In my post ‘Health Benefits of Exercise: a grossly underutilised therapy’, I have discussed the health benefits of muscular fitness. Keeping in view the health benefits of muscular fitness, strength training is now a popular form of exercise that is recommended by the World Health Organisation and the US national health organisations such as the American College of Sports Medicine and the American Heart Association, for most populations including adolescents, healthy adults, the elderly, and clinical populations (e.g. those individuals with cardiovascular disease, neuromuscular disease etc.).

People of various categories doing weight training.
Fig: People of various categories doing weight training
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Aerobic Exercise Prescription for Optimum Health Benefits

Introduction

In my post, Health Benefits of Exercise: a grossly underutilised therapy, I have discussed the various health benefits associated with physical activity, as a result of which exercise is now aptly being recognised as ‘medicine’. However, to derive optimal health benefits from exercise, an exercise program needs to follow certain parameters, similar to drug prescription, such as frequency, dose (amount), time (duration) and type (of physical activity). In my post Exercise Prescription for Optimal Health Benefits, I have discussed the FITT-VP principles for exercise prescription. In this post, I shall be discussing ‘prescription for aerobic exercise’ based on the FITT-VP principles. Prescription for strength training as per FITT-VP factors will be discussed in the next post. Aerobic exercise is referred to in the literature, both scientific and lay, by various terms. In the scientific literature, it is referred to as cardiorespiratory endurance or aerobic endurance, while colloquially it is referred to as aerobic exercise or just aerobic, or cardio, or cardio exercises, or cardio workout. In this post, these terms will be used interchangeably.

People engaging in aerobic activities.
People engaging in various aerobic activities.
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Exercise Prescription for Optimum Health Benefits

Introduction

Physical inactivity is now identified as the fourth leading risk factor for death globally, accounting for about 6% of the total deaths worldwide. Physical inactivity levels are rising globally, spanning all economic, educational and age strata. This has major implications for the general health of the people worldwide and for the prevalence of lifestyle diseases such as cardiovascular diseases (coronary heart disease and stroke), diabetes and cancer, and their risk factors such as raised blood pressure, raised blood sugar and overweight. Physical inactivity, i.e. lack of exercise, is estimated as the principal cause for approximately 21-25% of breast and colon cancer burden, 27% of diabetes and approximately 30% of coronary artery diseases (which can ultimately lead to heart attack). As per WHO, of the 56.9 million deaths globally in 2016, 40.5 million or 71% were due to lifestyle diseases. You can read about the total burden of these diseases in my post Chronic Diseases: the Silent Killers.

The image depicts a doctor advising a patient to exercise regularly.

Global health is being influenced by three trends: globalisation, urbanisation, and population ageing.

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Health Benefits of Exercise: a grossly underutilised therapy

Introduction

Exercise is being increasingly recognised to play an important role not only in the prevention but treatment as well of multiple lifestyle diseases (chronic diseases), health conditions and risk factors associated with these. In view of the above, exercise is now aptly being recognised as medicine. It is the cornerstone of lifestyle modification to achieve Holistic Health. However, like any other medicine, exercise too has some associated risks, though benefits of exercise on health, far outweigh the risks. However, before proceeding with the benefits and risks associated with exercise, it would be pertinent to understand some important related terms. Even though physical activity and exercise are often used interchangeably, they are not synonymous. The definition of these and some closely related terms are given below:

People of different age, gender and categories participating in different physical activities.
People of different age, gender and categories participating in different physical activities.
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