Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 184

In the last few years, there has been accumulating evidence from well‐designed studies supporting the benefit of physical activity in reducing total abdominal fat. There is no evidence that age limits abdominal fat loss secondary to exercise. Most studies have included middle‐aged to older populations who have a higher accumulation of abdominal and visceral fat than younger adults. They are more likely to demonstrate a greater magnitude of change than subjects with lower abdominal fat mass at baseline.⁷⁹ Furthermore, the potential for physical activity to attenuate the gain in visceral fat is evident in the obese as early as childhood.

Decreases in both total adipose tissue accumulation and its abdominal (visceral) deposition are achievable by both aerobic and resistive training, with significant changes in total body fat usually only in conjunction with an energy‐restricted diet or very large volumes of exercise (7 hours per week). Preferential visceral fat mobilisation is often seen in response to exercise and dietary intervention, which means that small amounts of total body weight or fat mass (5%) may be associated with substantial changes in visceral fat (25% or more), with important metabolic implications for the prevention or treatment of insulin resistance syndrome.⁸⁰

Exercise and diet in combination are the most effective non‐surgical treatment for obesity, and this approach is uniformly advocated by international consensus panels. The advantages of adding exercise to diet alone include greater weight loss, preservation of fat‐free mass and resting metabolic rate, improved fitness levels, correction of metabolic abnormalities associated with visceral obesity, and better long‐term adherence to dietary modifications, producing sustained weight maintenance. Therefore, robust exercise plus diet appear to represent an optimal evidence‐based treatment for obesity.