Evidence summary
A 2020 meta-analysis of seven RCTs reported a moderate effect of ≥ 4 weeks resistance training on physical function (standardised mean difference (SMD) 0.67 (95% CI 0.25 – 1.08), I2= 71%, n=346) among adults (aged ≥18 years) who are overweight or obese [1]. Subgroup analysis found resistance training to improve activities of daily living (SMD 0.59, 95% CI 0.04 -1.13, n=289, 6 studies) and gait speed (SMD 0.54, 95% CI 0.08-1.00, n=297, 7 studies). Physiotherapy Evidence Database (PEDro) quality scores of included studies, ranged from 4/10-8/10 and the median score was 4.5/10 [1].
Additionally, a 2021 network meta- analysis of RCTs conducted among adults with obesity and lower-limb osteoarthritis, found aerobic exercise training alone to be the most effective treatment to increase walking speed in the long term ((SMD) 0.51, (95% CI: 0.16–0.86), P= 0.92) when compared to usual care. The authors reported the quality of included studies to be medium-high [2].
Although data from one cross-sectional study [3] and one RCT (n=424) [4] suggest that obesity blunts the benefits of exercise on mobility in older adults, evidence from a large RCT of obese older adults (n=1613) found moderate intensity aerobic and resistance exercise reduced the risk of mobility disability. Exercise was effective and safe for participants across all ranges of BMI. [5].
Quality of evidence
- Consistent evidence that exercise improves mobility from meta-analyses and large scale RCTs.
Strength of recommendation
1A- Exercise is likely to improve mobility among most or all patients who are overweight or obese. Clear positive balance of benefit/risk.
Conclusion
Exercise interventions are likely to improve mobility including walking speed, walking ability, and the ability to do the activities of daily living. Exercise can be recommended to most people as safe and effective, unless they have absolute contraindication to exercise.
References
1.Orange ST, Madden LA, Vince RV. Resistance training leads to large improvements in strength and moderate improvements in physical function in adults who are overweight or obese: a systematic review. J Physiother. 2020;66:214-224. doi:10.1016/j.jphys.2020.09.009
2.Chu SF, Liou TH, Chen HC, Huang SW, Liao CD. Relative Efficacy of Weight Management, Exercise, and Combined Treatment for Muscle Mass and Physical Sarcopenia Indices in Adults with Overweight or Obesity and Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials. Nutrients. 2021;13:1992. doi:10.3390/nu13061992
3.Koster A, Penninx BW, Newman AB, et al. Lifestyle factors and incident mobility limitation in obese and non-obese older adults. Obesity (Silver Spring). 2007;15:3122-3132. doi:10.1038/oby.2007.372
4.Manini TM, Newman AB, Fielding R, et al. Effects of exercise on mobility in obese and nonobese older adults [published correction appears in Obesity (Silver Spring).2011 May;19(5):1106. King, Abby C [added]]. Obesity (Silver Spring). 2010;18:1168-1175. doi:10.1038/oby.2009.317
5.Kritchevsky SB, Lovato L, Handing EP, et al. Exercise’s effect on mobility disability in older adults with and without obesity: The LIFE study randomized clinical trial. Obesity (Silver Spring). 2017;25:1199-1205. doi:10.1002/oby.21860