EXERCISE GUIDELINES FOR PATIENTS WITH OBESITY: COMPARATIVE EFFECTIVENESS OF TRAINING MODALITIES AND CLINICAL CONSIDERATIONS
Main Article Content
Abstract
Exercise provides significant benefits for patients with obesity by reducing the risk of comorbidities that contribute to premature mortality. Typically, there are three primary forms of exercise recommended for individuals with obesity: aerobic exercise, resistance exercise, and flexibility exercises. Currently, numerous studies have investigated the effectiveness of various forms of exercise, with a particular focus on promoting weight loss, reducing body fat, preserving lean muscle mass, and enhancing energy metabolism.
According to a review of previous studies, high-intensity interval training (HIIT) has been shown to be effective in improving cardiorespiratory fitness, reducing body fat, and requiring less time compared to continuous moderate-intensity exercise. Subsequently, research has examined concurrent exercise modalities, such as aerobic exercise with resistance training and HIIT with resistance training. These combined approaches have demonstrated superior outcomes in terms of weight loss, fat reduction, and muscle mass preservation compared to single-mode exercise interventions.
This article aims to gather various beneficial exercise modalities for individuals with obesity, providing a guideline for developing the most appropriate and effective exercise programs.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Ahmed, B., & Konje, J. C. (2023). The epidemiology of obesity in reproduction. Best practice & research. Clinical Obstetrics & Gynaecology, 89, 102342. https://doi.org/10.1016/j.bpobgyn.2023.102342
American College of Sports Medicine. (2020). Exercise intensity: what you need to know. ACSM. https://www.acsm.org/docs/default-source/files-for-resource-library/exercise-intensity-infographic.pdf
American College of Sports Medicine. (2021). ACSM's guidelines for exercise testing and prescription. Lippincott Williams and Wilkins.
American Diabetes Association Professional Practice Committee, & American Diabetes Association Professional Practice Committee. (2022). 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement_1), S113-S124. https://doi.org/10.2337/dc22-S008
Baker, J. S., Supriya, R., Dutheil, F., & Gao, Y. (2022). Obesity: treatments, conceptualizations, and future directions for a growing problem. Biology, 11(2), 160. https://doi.org/10.3390/biology11020160
Bouamra, M., Zouhal, H., Ratel, S., Makhlouf, I., Bezrati, I., Chtara, M., Behm, D. G., Granacher, U., & Chaouachi, A. (2022). Concurrent training promotes greater gains on body composition and components of physical fitness than single-mode training (endurance or resistance) in youth with obesity. Frontiers in Physiology, 13, 869063. https://doi.org/10.3389/fphys.2022.869063
Cavalheri, V. (2023). Critically appraised paper: In overweight and obese adults with knee osteoarthritis, the addition of telehealth-delivered exercise and diet programs to online education improves pain and function. Journal of Physiotherapy, 69(3), 190. https://doi.org/10.1016/j.jphys.2023.05.002
Chen, C., Zhang, D., Ye, M., You, Y., Song, Y., & Chen, X. (2025). Effects of various exercise types on inflammatory response in individuals with overweight and obesity: a systematic review and network meta-analysis of randomized controlled trials. International Journal of Obesity, 49(2), 214-225. https://doi.org/10.1038/s41366-024-01649-6
Chen, X., He, H., Xie, K., Zhang, L., & Cao, C. (2024). Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta‐analysis of 84 randomized controlled trials. Obesity Reviews, 25(3), e13666. https://doi.org/10.1111/obr.13666
Chen, Z., Zhou, R., Liu, X., Wang, J., Wang, L., Lv, Y., & Yu, L. (2025). Effects of aerobic exercise on blood lipids in people with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials. Life, 15(2), 166. https://doi.org/10.3390/life15020166
Chuensiri, N., Suksom, D., and Tanaka, H. (2018). Effects of high-intensity intermittent training on vascular function in obese preadolescent boys. Childhood Obesity, 14(1), 41-49. https://doi.org/10.1089/chi.2017.0024
Elmaleh-Sachs, A., Schwartz, J. L., Bramante, C. T., Nicklas, J. M., Gudzune, K. A., & Jay, M. (2023). Obesity management in adults: a review. JAMA, 330(20), 2000-2015. https://doi.org/10.1001/jama.2023.19897
Engin, A. (2017). Adiponectin-Resistance in obesity. Advances in Experimental Medicine and Biology, 960, 415-441. https://doi.org/10.1007/978-3-319-48382-5_18
Fiatarone Singh, M., Hackett, D., Schoenfeld, B., Vincent, H. K., & Wescott, W. (2019). ACSM's guidelines for strength training. American College of Sports Medicine.
Gao, W., Liu, J. L., Lu, X., & Yang, Q. (2021). Epigenetic regulation of energy metabolism in obesity. Journal of Molecular Cell Biology, 13(7), 480-499. https://doi.org/10.1093/jmcb/mjab043
Gerosa-Neto, J., Antunes, B. M., Campos, E. Z., Rodrigues, J., Ferrari, G. D., Neto, J. C. R., & Bueno, C. R. (2016). Impact of long-term high-intensity interval and moderate-intensity continuous training on subclinical inflammation in overweight/obese adults. Journal of Exercise Rehabilitation, 12(6), 575-580. https://doi.org/10.12965/jer.1632770.385
Gilbertson, N. M., Eichner, N. Z. M., Gaitán, J. M., Pirtle, J. M., Kirby, J. L., Upchurch, C. M., Leitinger, N., & Malin, S. K. (2022). Impact of a short-term low calorie diet alone or with interval exercise on quality of life and oxidized phospholipids in obese females. Physiology & Behavior, 246, 113706. https://doi.org/10.1016/j.physbeh.2022.113706
Guedjati, M. R., & Taibi, A. D. (2023). The physical exercise in the management of obesity. IOSR Journal of Sports and Physical Education, 10(2), 27-34. https://doi.org/10.9790/6737-10022734
Huang, B., Xiong, X., Zhang, L., Liu, X., Wang, Y., Gong, X., Sang, Q., Lu, Y., Qu, H., Zheng, H., & Zheng, Y. (2021). PSA controls hepatic lipid metabolism by regulating the NRF2 signaling pathway. Journal of Molecular cell Biology, 13(7), 527-539. https://doi.org/10.1093/jmcb/mjab033
Jia, W., & Liu, F. (Eds.). (2021). Obesity: causes, consequences, treatments, and challenges. Journal of Molecular Cell Biology, 13(7), 463-465. https://doi.org/10.1093/jmcb/mjab056
Kajikawa, M., & Higashi, Y. (2022). Obesity and endothelial function. Biomedicines, 10(7), 1745. https://doi.org/10.3390/biomedicines10071745
Karacabey, K. (2009). The effect of exercise on leptin, insulin, cortisol and lipid profiles in obese children. Journal of International Medical Research, 37(5), 1472-1478. https://doi.org/10.1177/147323000903700523
Khodamoradi, K., Khosravizadeh, Z., Seetharam, D., Mallepalli, S., Farber, N., & Arora, H. (2022). The role of leptin and low testosterone in obesity. International Journal of Impotence Research, 34(7), 704-713. https://doi.org/10.1038/s41443-022-00534-y
Kivimäki, M., Strandberg, T., Pentti, J., Nyberg, S. T., Frank, P., Jokela, M., Ervasti, J., Suominen, S. B., Vahtera, J., Sipilä, P. N., Lindbohm, J. V., & Ferrie, J. E. (2022). Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. The lancet. Diabetes & Endocrinology, 10(4), 253-263. https://doi.org/10.1016/S2213-8587(22)00033-X
Kudchadkar, G., Akinsiku, O., Hefner, M., Ozioma, P. U., Booe, H., & Dhurandhar, N. V. (2024). Shedding the weight of exercise for obesity management. International Journal of Obesity, 48(10), 1357-1358. https://doi.org/10.1038/s41366-024-01527-1
Kwaifa, I. K., Bahari, H., Yong, Y. K., & Noor, S. M. (2020). Endothelial Dysfunction in Obesity-Induced Inflammation: Molecular Mechanisms and Clinical Implications. Biomolecules, 10(2), 291. https://doi.org/10.3390/biom10020291
Livhits, M., Mercado, C., Yermilov, I., Parikh, J. A., Dutson, E., Mehran, A., Ko, C. Y., & Gibbons, M. M. (2010). Exercise following bariatric surgery: systematic review. Obesity Surgery, 20(5), 657-665. https://doi.org/10.1007/s11695-010-0096-0
McInnis, K. J. (2000). Exercise and obesity. Coronary Artery Disease, 11(2), 111-116. https://doi.org/10.1097/00019501-200003000-00004
Mengistu, F. A., Lake, Y. A., Andualem, M. E., Miherete, Y. D., & Zewdie, S. A. (2025). Impact of aerobic, resistance, and combined training on cardiometabolic health-related indicators in inactive middle-aged men with excess body weight and obesity. Frontiers in Physiology, 16, 1519180. https://doi.org/10.3389/fphys.2025.1519180
Monteiro, P. A., Chen, K. Y., Lira, F. S., Saraiva, B. T., Antunes, B. M., Campos, E. Z., & Freitas, I. F., Jr (2015). Concurrent and aerobic exercise training promote similar benefits in body composition and metabolic profiles in obese adolescents. Lipids in Health and Disease, 14, 153. https://doi.org/10.1186/s12944-015-0152-9
O'Donoghue, G., Blake, C., Cunningham, C., Lennon, O., & Perrotta, C. (2021). What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis. Obesity Reviews, 22(2), e13137. https://doi.org/10.1111/obr.13137
Oppert, J. M., Bellicha, A., van Baak, M. A., Battista, F., Beaulieu, K., Blundell, J. E., ... & Busetto, L. (2021). Exercise training in the management of overweight and obesity in adults: synthesis of the evidence and recommendations from the European association for the study of obesity physical activity working group. Obesity Reviews, 22, e13273. https://doi.org/10.1111/obr.13273
Pennings, N., Varney, C., Hines, S., Riley, B., Happel, P., Patel, S., & Bays, H. E. (2025). Obesity management in primary care: A joint clinical perspective and expert review from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) - 2025. Obesity Pillars, 14, 100172. https://doi.org/10.1016/j.obpill.2025.100172
Phanchai, S. (2013). Treatment of obesity with bariatric surgery. In The 29th Annual Academic Conference 2013, 28(supplement), 116-126. https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/14776
Pranoto, N. W., Fauziah, V., Anugrah, S., Fitriady, G., Setyawan, H., Geantă, V. A., ... & Ndayisenga, J. (2024). The effectiveness of diet and exercise in the management of obesity. Retos, 58, 951-959. https://doi.org/10.47197/retos.v58.105295
Robergs, R.A., and Robert, S.O. (1997). Exercise physiology, exercise, performance, and clinical application. Mos-year Book, Inc.
Rosa-Neto, J. C., and Silveira, L. S. (2020). Endurance exercise mitigates immunometabolic adipose tissue disturbances in cancer and obesity. International Journal of Molecular Sciences, 21(24), 9745. https://doi.org/10.3390/ijms21249745
Sawyer, B. J., Tucker, W. J., Bhammar, D. M., Ryder, J. R., Sweazea, K. L., & Gaesser, G. A. (2016). Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults. Journal of Applied Physiology, 121(1), 279-288. https://doi.org/10.1152/japplphysiol.00024.2016
Smith-Ryan, A. E., Melvin, M. N., & Wingfield, H. L. (2015). High-intensity interval training: modulating interval duration in overweight/obese men. The Physician and Sportsmedicine, 43(2), 107-113. https://doi.org/10.1080/00913847.2015.1037231
Stenglein, J. (2017). Morbid obesity. In Aglio, L. S., & Urman, R. D. (Eds.), Anesthesiology (pp. 237-245). Springer.
Suksom, D., Phanpheng, Y., Soogarun, S., & Sapwarobol, S. (2014). Step aerobic combined with resistance training improves cutaneous microvascular reactivity in overweight women. The Journal of Sports Medicine and Physical Fitness, 55(12), 1547-1554.
Tschakert, G., & Hofmann, P. (2013). High-intensity intermittent exercise: methodological and physiological aspects. International Journal of Sports Physiology and Performance, 8(6), 600-610. https://doi.org/10.1123/ijspp.8.6.600
Tucker, S., Bramante, C., Conroy, M., Fitch, A., Gilden, A., Wittleder, S., & Jay, M. (2021). The most undertreated chronic disease: addressing obesity in primary care settings. Current Obesity Reports, 10(3), 396-408. https://doi.org/10.1007/s13679-021-00444-y
Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., Armamento-Villareal, R., & Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older adults. The New England Journal of Medicine, 376(20), 1943-1955. https://doi.org/10.1056/NEJMoa1616338
WHO Expert Consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England), 363(9403), 157-163. https://doi.org/10.1016/S0140-6736(03)15268-3
Wiechert, M., & Holzapfel, C. (2021). Nutrition concepts for the treatment of obesity in adults. Nutrients, 14(1), 169. https://doi.org/10.3390/nu14010169
Worasettawat, T., Udomsawangsup, S., Tanaka, H., & Suksom, D. (2021). Cardiovascular responses to acute bouts of continuous and high-intensity interval exercise in morbidly obese adults. Journal of Exercise Physiology Online, 24(4), 45-54.
Xia, X. D., Alabi, A., Wang, M., Gu, H. M., Yang, R. Z., Wang, G. Q., & Zhang, D. W. (2021). Membrane-type I matrix metalloproteinase (MT1-MMP), lipid metabolism, and therapeutic implications. Journal of Molecular Cell Biology, 13(7), 513-526. https://doi.org/10.1093/jmcb/mjab048
Yu, J., Lee, E., Choi, J. H., Sun, Y., Woo, S., Cho, S., Hwang, D., Kim, S. W., Kim, J., Lim, K., & Park, H. Y. (2025). Effects of a 6-week concurrent training program combining resistance and various modalities of aerobic exercise in obese women with prehypertension: a randomized controlled trial. Metabolites, 15(4), 278. https://doi.org/10.3390/metabo15040278
Zang, B. Y., He, L. X., & Xue, L. (2022). Intermittent fasting: potential bridge of obesity and diabetes to health? Nutrients, 14(5), 981. https://doi.org/10.3390/nu14050981
Zhang, H., Tong, T. K., Qiu, W., Zhang, X., Zhou, S., Liu, Y., & He, Y. (2017). Comparable effects of high-intensity interval training and prolonged continuous exercise training on abdominal visceral fat reduction in obese young women. Journal of Diabetes Research, 2017, 5071740. https://doi.org/10.1155/2017/5071740