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Obesity represents a significant public health concern, with one-third of adults classified as living with obesity in the United States. Obesity correlates with cardiometabolic comorbidities that can decrease the quality of life.[1][2] Researchers have proposed that exercise is an important lifestyle measure to maintain a healthy weight. This review will cover the role of exercise in obesity and fitness. Obesity is an excessive fat accumulation in adipose tissues defined by a body mass index (BMI) of 30 kg/m2 and above. Individuals in the BMI range of 25 to 30 kg/m2 are categorized as overweight, while a BMI of 40 kg/m2 and above is regarded as morbid obesity.[3] Obesity correlates with an individual’s increased risk of cancers, stroke, metabolic disease, heart failure, and other cardiovascular conditions, highlighting the need to reduce the incidence and prevalence of obesity.[4][5][6] Chronic low-grade inflammation associated with obesity is hypothesized to have associations with adverse cardiometabolic adverse effects.[7] Although short-term inflammation is beneficial to initiate an immune response, chronically elevated levels of inflammation exhaust the immune system and contribute to immune dysfunction.[2] Researchers posit that this inflammation is stimulated by the excess adipose tissue, which has consistently been shown to play a role as an active endocrine organ.[8] Reducing adipose tissue is one of the ways to reduce weight in individuals with obesity and is necessary to mitigate negative cardio-metabolic comorbidities in obesity. Two methods exist that can effectively decrease adipose tissue and include: Dietary modification Energy expenditure modification (ie, exercise)

Obesity is an excessive fat accumulation in adipose tissues defined by a body mass index (BMI) of 30 kg/m2 and above. Individuals in the BMI range of 25 to 30 kg/m2 are categorized as overweight, while a BMI of 40 kg/m2 and above is regarded as morbid obesity.[3] Obesity correlates with an individual’s increased risk of cancers, stroke, metabolic disease, heart failure, and other cardiovascular conditions, highlighting the need to reduce the incidence and prevalence of obesity.[4][5][6] Chronic low-grade inflammation associated with obesity is hypothesized to have associations with adverse cardiometabolic adverse effects.[7] Although short-term inflammation is beneficial to initiate an immune response, chronically elevated levels of inflammation exhaust the immune system and contribute to immune dysfunction.[2] Researchers posit that this inflammation is stimulated by the excess adipose tissue, which has consistently been shown to play a role as an active endocrine organ.[8] Reducing adipose tissue is one of the ways to reduce weight in individuals with obesity and is necessary to mitigate negative cardio-metabolic comorbidities in obesity. Two methods exist that can effectively decrease adipose tissue and include: Dietary modification Energy expenditure modification (ie, exercise) Thus, increasing energy expenditure can help reduce excess adipose tissue and obesity. The current guidelines by the American College of Sports Medicine (ACSM) include aerobic or anaerobic exercise. Aerobic exercise (eg, running, cycling, rowing) is an exercise that exhausts the oxygen in the muscles. Still, oxygen consumption is sufficient to supply the energy demands placed on the muscles and does not need to derive energy from another source.[9] On the other hand, anaerobic exercise or resistance exercise, eg, weight lifting)is oxygen consumption insufficient to supply the energy demands placed on the muscles, and muscles must break down other energy supplies, such as sugars, to produce energy and lactic acid.[9] Physical activity is included in the exercise, although it does not necessarily include structured exercise plans/sessions.

Thus, increasing energy expenditure can help reduce excess adipose tissue and obesity. The current guidelines by the American College of Sports Medicine (ACSM) include aerobic or anaerobic exercise. Aerobic exercise (eg, running, cycling, rowing) is an exercise that exhausts the oxygen in the muscles. Still, oxygen consumption is sufficient to supply the energy demands placed on the muscles and does not need to derive energy from another source.[9] On the other hand, anaerobic exercise or resistance exercise, eg, weight lifting)is oxygen consumption insufficient to supply the energy demands placed on the muscles, and muscles must break down other energy supplies, such as sugars, to produce energy and lactic acid.[9] Physical activity is included in the exercise, although it does not necessarily include structured exercise plans/sessions. The measurement of exercise is conducted in “metabolic equivalent tasks” (METs), which roughly equate to the effort and energy expenditure it takes for an individual to sit quietly. Physical activity is frequently incorporated into different lifestyle interventions, highlighting the need for regular daily physical activity. Physical activity in the general lifestyle includes goal setting, problem-solving, leisure-time physical activity, and activity used for commuting. Outcomes of interest include cardiorespiratory fitness, body composition, and muscular fitness. Recently, much literature has shown the positive effects of exercise on physical health and cognitive and emotional well-being in people of all ages.[10]

The healthcare team (nurse practitioner, primary care provider, internist, endocrinologist, bariatric surgeon, pharmacist, and obesity nurse) should implement many strategies to increase physical activity and fitness for individuals living with obesity, including utilizing “exercise vital signs,” tracking exercise, motivational interviewing, and periodic check-ins. Currently, the following could potentially be implemented into practice to encourage patients living with obesity to exercise. Utilizing exercise as a vital sign in individuals with obesity: Obtaining current exercise and physical activity habits from patients could serve as another vital sign and would include understanding the intensity, mode, and duration of the exercise performed weekly by the patient. Providers could have electronic medical records (EMRs) to prompt patients who are living with obesity to have discussions with the patient regarding their physical activity. These prompts on the EMR can be input by the medical assistants who may ask at the beginning of the appointment, just like taking blood pressure and pulse. Utilizing exercise trackers: Several devices can track heart rate, motion, exercise, moderate to vigorous physical activity (MVPA), and beyond. Providers could potentially use these data to ensure that the patient is exercising and could point to potential problems that may arise from abnormal heart or exercise responses. Examples include smartwatches, cellular smartphones, pedometers, heart rate monitors, etc. Motivational Interviewing: To drive the point home further, nurses, CNAs, physicians, and anyone else involved in the healthcare setting for this patient could employ/use motivational interviewing techniques with the patient to reflect, plan, and execute different action plans to ensure that patients are meeting their exercise goals.

Motivational Interviewing: To drive the point home further, nurses, CNAs, physicians, and anyone else involved in the healthcare setting for this patient could employ/use motivational interviewing techniques with the patient to reflect, plan, and execute different action plans to ensure that patients are meeting their exercise goals. Check-Ins: Technology is allowing individuals to interact now more than ever. Physicians and patients could potentially use these technological advances to develop relationships further. Utilizing technology to have doctor-patient check-ins regarding their exercise may increase the adherence of obese individuals to exercise programs. These could include developing an app that alerts patients and the doctor when exercise habits are not sufficient, thus prompting a check-in from the physician using motivational interviewing and asking why the patient has or hasn’t exercised according to plan.

If the patient can exercise, exercise may be the preferred route to decrease disease symptoms and future risk compared to alternative pharmaceuticals that may exacerbate symptoms. An open and communicative relationship between the physician, healthcare team, and the patient must be present to suggest adding exercise to the patient's lifestyle to decrease obesity and improve adverse side effects.[22] Obesity disproportionately affects individuals with a lower socioeconomic status, and these individuals may not have access to a safe exercise space, may not understand the importance of exercise, or may not have the time during the day to exercise due to other obligations. Therefore, the relationship between the care providers and the patient becomes significant in implementing exercise in obese individuals.