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weight. For any given weight loss, fat-free mass (FFM) is better preserved in exercising than non-exercising subjects: this is likely to be important in the long term because FFM is the best predictor of resting metabolic rate, which is the largest contributor to daily energy expenditure for all but active athletes.

There are other beneficial effects of exercise that are independent of its effects on weight loss. Regular exercise reduces blood pressure, improves insulin sensitivity, both in association with or independent of weight loss. Favorable effects on the atherogenic lipid profiles have also been reported with exercise and physical training in obese subjects. Such benefits are substantial and should be emphasized to all patients; however, persuading an obese person to participate in regular physical activity and to maintain exercise as a part of daily routine is not easy.

One of the most consistent findings in studies of physical activity is enhanced weight maintenance for at least 2 years from the start of the intervention. It is not necessary to increase maximal oxygen uptake in the obese to derive benefit from exercise: metabolic evidence of fitness is achieved with less vigorous exercise.

Physical activity recommendations suggest 30 min of moderate activity on at least 5 days of the week. This level of activity is associated with improved fitness and protection from cardiovascular diseases. When using exercise solely as a strategy for weight reduction, longer duration of daily activity of a moderate intensity lasting 45-60 min is required.

Reduction in the time spent in sedentary behaviors (such as television watching) is an important strategy for increasing physical activity and energy expenditure. Similarly, encouraging findings have been observed in children and adolescents advised to include more lifestyle activity (e.g., walking versus car use) compared to those with traditional programs of activity.

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