• Jean-Michel Oppert, Alice Bellicha, and Cécile Ciangura.
• Department of Nutrition, Pitié-Salpêtrière university hospital (AP-HP), Sorbonne university, Centre for research on human nutrition (CRNH IdF), Institute of cardiometabolism and nutrition (ICAN), 47-83 boulevard de l'Hôpital 75013 Paris, France; Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inrae U1125/Cnam/USPN, 74 rue Marcel Cachin 93017 Bobigny, France. Electronic address: jean-michel.oppert@aphp.fr.
• Eur. J. Intern. Med. 2021 Nov 1; 93: 8-12.

AbstractPhysical activity and exercise have many benefits in persons with obesity, helping with weight loss, body fat loss, abdominal visceral fat loss and possibly with weight maintenance after weight loss. The effect of exercise training (endurance or endurance plus resistance or high-intensity interval training) alone on weight loss as outcome appears relatively modest, amounting to only a few kg. However, endurance training during weight loss has been shown to increase V̇O2max and resistance training during weight loss leads to lower loss in lean body mass and increased muscle strength. In addition, higher physical activity levels improve cardiovascular risk, whatever weight variations. Specifically, physical activity or exercise is part of lifestyle measures for prevention of type 2 diabetes and substantially helps with metabolic control in patients with type 2 diabetes. The importance of physical activity counselling and exercise prescription in the management strategy will depend on specific treatment objectives as defined for a given patient, including weight loss, prevention of weigh regain, prevention of cardio-metabolic comorbidities, lean body mass preservation but also improvement in quality of life or development of social links. The 5 A's strategy consisting in: Ask, Assess, Advise, Agree, Assist (or Arrange) appears well adapted in this setting. Professionals need to be aware of the many barriers patients with obesity may meet on their way to increase habitual physical activity as specific solutions should be proposed. A major challenge is how to improve adherence to new physical activity habits over time.Copyright © 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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