114 good practice in physical activity interventions

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11.4 GOOD PRACTICE IN PHYSICAL ACTIVITY INTERVENTIONS The following good practice points are based on the clinical experience of the guideline development group and are provided to guide safe implementation of the physical activity recommendations. ; It is important to ensure that individuals have no contraindications to exercise before commencing a physical activity programme. The physical activity readiness questionnaire (PAR-Q) provides a quick and validated mechanism for determining whether individuals should undergo further screening investigations prior to embarking on a programme of increased physical activity. The PAR-Q physical activity readiness questionnaire is given in Annex 8. ; Moderate intensity physical activity increases the rate of breathing and body temperature, but conversation is comfortable at this pace. Heart rate is in the range 55-70% of age-predicted maximum (220 minus age). For obese, sedentary individuals, brisk walking ( ie walking at faster than normal pace ) often constitutes moderate intensity physical activity. Energy is expended at a faster rate during vigorous activity compared with moderate intensity activity, which means that the same energy can be expended in a shorter period of time. In vigorous intensity physical activity, conversation is harder, but still possible. Heart rate is 70-90% of age-predicted maximum. Some individuals may prefer this approach, as it is less time consuming, but vigorous exercise is probably not appropriate for the very obese ( BMI > approximately 35 kg/m 2 ). ; Physical activity can be accumulated over the course of the day in multiple small sessions ( of at least 10 minutes duration each ) and does not need to be performed in a single session.
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26 MANAGEMENT OF OBESITY ; Sedentary individuals should build up to their physical activity targets over several weeks, starting with 10-20 minutes of physical activity every other day during the first week or two of the programme, to minimise potential muscle soreness and fatigue. Individuals choosing to incorporate vigorous intensity activity into their programme should do this gradually and after an initial 4-12 week period of moderate intensity activity. ; Walking is an excellent form of physical activity for overweight and obese people. Walking one kilometre ( 0.62 miles ) on flat ground burns approximately 60 kcal for a 70 kg person and 90 kcal for a 100 kg person. Such weight-bearing physical activity may be difficult for some individuals with BMI over approximately 35 kg/m 2 , particularly for those with joint problems. In these individuals, gradually increasing non-weight-bearing moderate intensity physical activities ( eg cycling, swimming, water aerobics, etc ) should be encouraged.
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1 ++ 1 ++ 1 ++ 1 ++ 1 ++ 27 12 PSYCHOLOGICAL/BEHAVIOURAL INTERVENTIONS IN ADULTS 12 Psychological/behavioural interventions in adults A meta-analysis conducted for the 2006 NICE guideline examined studies combining psychological interventions into weight management programmes.
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Christopher Reinemann
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