20 Key Points 1. Do not restrict energy intake without increasing physical activity 2. Concentrate on fatness, forget fitness 'Getting fit' is not a pre-requisite for fat loss. However, 'fitness' activity appears to be the most beneficial form of exercise to improve metabolic function (also called 'metabolic fitness' e.g. to lower blood lipids, to improve insulin function) even without weight loss. 3. 'Do more 'incidentally' Increasing incidental movement carried out in day-to-day life, without vigorous exertion, will increase energy expenditure. 4. Think of movement as an opportunity, not an inconvenience All movement contributes to energy loss, no matter how small and more is better than little. 5. Don't over-do it irregularly. Do it easily every day Although fitness can be improved with intense physical activity 3-4 times a week, movement for fat loss should optimally be carried out every day. 6. Do it in short bouts Carry out small regular bouts of moderate intensity (e.g. 10 min) physical activity like walking 3-4 times a day to burn body fat, rather than longer bouts which can't be sustained.

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One of the problems with diets that markedly restrict food energy intake is that they cause a compensatory drop in basal metabolic rate (BMR), which therefore tends to counteract the effect of energy restriction. Such an effect has obvious survival value during famine. However, provided the energy restriction is only modest (about 300 kcal less per day), the addition of physical activity to a dietary regimen will prevent the decline in BMR. Randomised studies which have looked at the relative merits of exercise versus energy restriction show similar weight losses at 1 year, but the exercise group had not lost any muscle mass, whilst the dieting only group had lost some muscle mass. The exercise group had only lost body fat. The combination of energy restriction and increased physical activity is additive. Exercise alone continues to be effective beyond 6 months. It also reduces abdominal fatness that may be more in evidence than change in total body weight, and of greater consequence, since abdominal fat rather than total body fat has been linked with an increased risk of heart disease, cancer and diabetes.

Exercise for fitness is quite different to exercise for fatness. Exercise for fitness is usually prescribed under the acronym FITT (frequency, intensity, time and type). The time and intensity dimensions for developing cardiovascular fitness usually suggest a prolonged exercise session at a heart rate elevated to around 60-80% of maximum. Recent findings suggest this may not be necessary for reducing body fatness. Two groups of sedentary obese women were asked to walk for either 40min in one session, or 4 lots of 10 minutes throughout the day over 5 days a week. The women who were able to carry out the short bursts of activity more regularly over a 5 month period resulted in a trend towards greater fat loss while having similar improvements in fitness levels.
Jakicic JM et al. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness and weight loss in ovwerweight women. Int J Obesity 1995; 19: 893-901

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