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Physical Activity Review, vol. 10(2), 2022
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Original Article
doi: 10.16926/par.2022.10.18
Effect of Physical Exercise on Adiposity and Physical
Fitness in Middle Age Men with Different Body Mass
Václav Bunc
Charles University, Faculty of Physical Education and Sport, Czech Republic
Authors' Contribution: A – Study Design, B – Data Collection, C – Statis tical Analysis, D – Manuscript Preparation
____________ ______________________________________________ ________ _____________________________________________ ______________________________________________ ____
Abstract
Purpose: Overweight and/or obesity is a growing problem over the world. Alongside a range of health
problems associated with increased body mass (BM) – adiposity and reducing of fitness level it is an
important limiting factor for realization of regular physical exercise and quality of life. Therefore, the
aim of our study was to verify the effect of physical intervention based on walking in men of middle
age with different weight status with minimal changes in their eating habits. Material and Methods:
Study was carried out in 25 middle age men with normal BM (mean age=43.7±3.6 years; BM=78.3±3.9
kg; height=177.5±4.6 cm; %BF=22.1±2.1 %, VO2peak=33.2±3.1 ml/kg.min), 26 overweight men (42.0
±2.9; 89.9±3.1; 178.1±4.0; 27.9±2.2; 30.2±3.9) and 18 obese men (43.8±3.0; 97.4±4.6; 178.3±3.2;
33.1±3.4; 24.1±4.2). All these subjects were without regularly movement training before the starting
of intervention. Body composition was assessed by bioimpedance method using prediction equations
that are valid for the Czech men population, functional variables were assessed on a treadmill. Results:
The energy content per kg BM of weekly exercise for subjects with normal BM was 20.40±4.51 kcal/kg
(13.4 – 20.4 kcal/kg), in overweight 20.36±3.00 kcal/kg (15.4 – 24.5), and in obese 20.33±3.39 kcal/kg
(17.6 – 24.0). Reduction in %BF ranged from 9.4±2.7 % in obese to 8.6±2.1 % in normal BM of starting
value, ECM/BCM relationship was decreased from 11.0±1.4 % in subjects with normal BM to
12.2±1.9 % in obese, and in VO2peak increased from 10.3±2.2 % in normal BM to 12.7±2.6 % in obese. In
men differing in BM are absolute changes in adiposity and aerobic fitness like a result of imposed
movement intervention substantively and statistically significant (p<0.05, d≥0.05). On the contrary,
differences in percentages of pre-intervention values are non-significant. Conclusion: Exercise program
with a similar energy content, form and intensity causes the similar changes in adiposity and in
functional performance in middle age men, differing in BM. Movement intervention based on walking
reduces body weight and at the same time improves the morphological preconditions for physical
activity.
Keywords: middle age men, walking, body mass, body composition, movement predispositions
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Author for correspondence: Václav Bunc, email: bunc@ftvs.cuni.cz
Recevied: 17.01.2022; Accepted: 19.02.2022; Published online: 6.07.2022
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Cite this article as: Bunc V. Effect of Physical Exercise on Adiposity and Physical Fitness in Middle Age Men with
Different Body Mass. Phys Act Rev 2022; 10(2): 23-31. doi: 10.16926/par.2022.10.18
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INTRODUCTION
In recent decades, the prevalence of obesity has continued to increase across the world [1],
representing a considerable global public health issue [2]. Obesity is defined as an excessive or
abnormal fat accumulation, presenting health risks related to multiple chronic conditions. Physical
activity is a modifiable factor for obesity, which was reported to be correlated with the built
environment.
The obesity has doubled worldwide and is considered the fifth risk factor for mortality. Future
projections estimates a 33% increase in obesity and 130% increase in severe obesity prevalence in
2030 [3]. Obesity is associated with a reduction in individual mobility, aggravating previous sedentary
lifestyle [4, 5]. Activities of daily living (ADL) are impaired due not only to excessive body fat
accumulation but also to mechanical factors that might reduce walking capacity.
Adipose tissue represents the largest energy depot in the human body. More and more people
exhibit excessive fat deposition in adipose tissue, which leads to obesity, a multifactorial disease with
both adverse health effects and economic implications. Although obesity has troubled humanity since
ancient times, it has reached epidemic proportions only in recent years [6-9]. Since its primary cause is
a chronic imbalance between energy intake and energy expenditure in favor of the former, the road to
fighting obesity (excluding pharmaceutical interventions) necessarily passes through creating a
negative energy balance [10].
Since many obese people have reduced physical fitness, are not familiar with exercise, and are
at increased risk for musculoskeletal injuries due to excess body weight, it is important to prescribe
exercise that is safe and makes them feel comfortable, thus ensuring adherence to the exercise training
program. Walking on flat terrain, which is the basic locomotor activity of a person and is maximally
adapted to it, meets these criteria. Such a program should be defined by the appropriate parameters of
frequency, duration, intensity, type, and progressivity, which, in turn, should be determined according
to individual abilities, preferences, and responses. It is also recommended that exercise be supervised
by a specialized trainer, at least during an initial period. Despite the proven health benefits of aerobic
exercise training, traditional modes, such as land walking and running, are often associated with an
increased risk of musculoskeletal injury due to accumulated stress on the lower extremities [11],
particularly in the obese. Furthermore, pain and injury from exercise are often cited as reasons for
discontinuing exercise training. The recommendations apply to both women and men, as there seem
to be no differences between sexes in the weight loss caused by equivalent exercise [7].
Regular physical activity (PA) is an important component of overall health. PA is well known to
improve cardiorespiratory fitness, blood pressure, and body composition, which are all negatively
correlated with the risks of chronic disease [12]. PA also plays a role in body weight regulation
through its effects on energy expenditure and energy intake, providing a potential disruption to the
energy balance equation [13]. Because exercise creates an energy deficit that may perturb
homeostasis and hormone levels, the effects of exercise on energy intake are of interest.
Evidence summarized mainly in many medical staff supports the view that exercise constitutes
an indispensable tool in the management of obesity. Yet, in our experience, this tool is often
underestimated, and preference is given to other means such as dieting, medication, and surgery.
People who are overweight or obese often claim that they are not able to implement an exercise
program as individuals of normal body mass, and if they complete the program, its results will be
significantly worse than that of people of normal weight [11,14].
Therefore, the aim of our study was to verify the effect of physical intervention based on
walking in men of middle age with different weight status with minimal changes in their eating habits.
MATERIALS AND METHODS
Participants
Physically inactive, normal body mass, overweight, and obese men were recruited from the
Prague and surroundings communities to participate in the study. Potential volunteers were recruited
through informational flyers, through e-mail announcements, and by word of mouth. Volunteers were
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Table 1. Demographic and selected functional data of subjects and practical and statistical significance
upon entry to the study.
Variables
NBM
(1)
OV
(2)
OB
(3)
1-2
1-3
2-3
Number
25
26
18
Age (years)
43.7±3.6
42.0±2.9
43.8±3.0
NS
NS
NS
Body mass (kg)
78.3±3.9
89.9.7±3.1
97.4±4.6
* α
** αα
** αα
Body height (cm)
177.5±4.6
178.1±4.0
178.3±3.2
NS
NS
NS
%BF (%)
22.1±2.1
27.9±2.2
33.1±3.4
** α
** α
** α
BCM/ECM
0.85±0.03
0.93±0.04
1.01±0.04
NS
** α
NS
VO2peak.kg-1 (ml.kg-1.min-1) - BM
32.2±2.64
29.1±2.9
26.1±3.2
NS
** α
NS
VO2peak.kg-1 (ml.kg-1.min-1) - FFM
41.3±2.7
40.4±2.8
39.1±3.1
NS
NS
NS
NBM – normal body mass, OV – overweight, OB – obesity, BCM – body cell mass, ECM – extracellular mass,
*p<0.05, **p<0.05, α d=0.5, αα d=0.6
screened to ensure that they had not participated in regular aerobic activity for the previous 3 months
(physically inactive) and were classified as normal body mass, overweight or obese by either body
mass index (BMI) or percent body fat as measured by whole body bioimpedance analysis. Subjects
were stratified according to the Czech standards for risk of cardiovascular disease, and those for
whom it was required underwent a physical examination by a cardiologist before participation in the
experiment. Preliminary anthropometrical and physiological characteristics of the all subjects who
completed the study are presented in Table 1.
The study protocol was reviewed and approved by the local Ethics Committee Faculty of P.E.
and Sports and followed the guidelines of the World Medical Assembly Declara-tion of Helsinki.
Written informed consent to participate was provided by guardians and verbal assessment was
provided by the participants.
Methods
Subjects were instructed to maintain their accustomed dietary and physical activity habits
throughout the course of the study. No attempt was made to modify diet or activity outside of the
exercise training protocol. To verify compliance with these instructions, dietary and activity habits
were assessed on two occasions by questionnaire coinciding with the beginning and end of exercise
training.
The walking exercise used in this study is one of the most widely known cardiovascular
exercises [15]. Walking is the most fundamental physical activity of humans to which the individual is
maximally adapted. It is the easiest and the most familiar form of exercise, both physically and
mentally. Most people enjoy walking as a type of exercise regardless of age, fitness level, or technique,
and it is associated with very little risk of injury. It is therefore well suited for individuals who have
minimal experience with movement training.
In order to achieve the greatest possible effect of physical intervention and especially to
maintain adherence to PA, a physical program was designed for a duration of 15 weeks. Each session
included approximately 10 minutes of warm-up and cool-down, during which participants focused on
range of motion and active stretching. The main portion of the walking exercise program, which
consisted of 3 walking sessions per week, was designed following the ACSM physical activity
guidelines for adults between the ages of 18–64 years [16]. In order to reap greater health benefits
from the exercise program, a minimum of 300 minutes per week. 100 minutes per session was
ensured with mean intensity of exercise on the level HR ranged from 80 to 90% of age-recommended
values. Intensity - walking speed in field conditions was controlled using Sportesters (Polar Oy,
Finland) or Smart mobile phones. The outside temperatue during walking was in the range of 15 - 20
degrees Celsius. Body composition was determined by the whole-body bioimpedance in the lying
position.
The electrodes were in tetrapolar configuration in the places recommended by the
manufacturer (BIA 2000, Datainput, Germany). Predictive equations for calculation of body
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composition variables (BC, BCM – body cell mass, ECM – extracellular mas) were modified for the
Czech population according to verification by DEXA method. We use the ECM/BCM ratio to assess the
exercise load assumptions, where ECM is the extracellular mass and BCM is the body cell mass. It holds
that FFM = ECM + BCM. The lower this value, the better the movement preconditions the subject has.
For trained athletes, we find values of this coefficient lower than 0.7, on the contrary, the values of
untrained individuals are close to 1.00 [17,18].
The body cell mass is calculated using the FFM and phase angle between whole impedance
vector and resistance [19]. The FFM was calculated according to modified formula of Deurenberg et al.
[20]. An incremental maximal graded exercise test was conducted by walking on a motor-driven
treadmill for VO2peak determination. Oxygen consumption during exercise was assessed using an
automated gas analysis system The maximal functional variables determined on a treadmill with slope
of 5% during a progressive walking test until subjective exhaustion. After two familiar walking speeds
of 3 and 5 km / h with zero treadmill, the initial walking intensity of 3 km / h on the treadmill with a
slope of 5% was increased every minute by 1 km / h until the subject subjectively exhausted. The
cardiorespiratory variables were measured in an open system using an on line method by TEEM 100
(Aerosport, USA) and/or Metalyzer 3b (CORTEX, Germany). All analyzers were checked before and
after each exercise test series by a calibration gas of known concentration. The ventilation was
controlled before and after test series by mechanical pump. Each subject was tested using the same
metabolic equipment at pretraining and posttraining assessment periods. VO2peak was taken as the
highest 20-s average oxygen uptake achieved during the exercise test. HR was monitored continuously
by Sportester Polar.
The subjects were verbally encouraged to continue the exercise to the point of exhaustion. To
acknowledge that the subjects had achieved VO2peak, at least two of the following three criteria were
met: (a) a plateau of VO2 (change <150 ml·kg-1·min-1); (b) respiratory exchange ratio (RER) ≥1.10; and
(c) heart rate (HR) within 10 beats·min-1 of the maximum level expected for age of the maximum level
expected for age. Energy when walking on flat terrain was calculated for walking speeds lower than 7
km.h-1 from the linear relationship between movement speed and oxygen consumption, which applies
to walking speeds in the range of 3 - 7 km·h-1 [20]. VO2.kg-1 (mL·kg−1·min−1) = 2.957*v (km·h-1) + 2.777.
We used the relation 1 l VO2 = 4.8 kcal for load intensity with predominantly aerobic payment of
energy requirements [21,22].
Data analysis
The normality of distribution was verified by the Shapiro-Wilk test. The parametric paired t-
test was used for the assessment of statistical significance of the differences pre-intervention and post-
intervention data. The level of statistical significance for all the used tests was set at p<0.05. Practical
significance was assessed using the effect size by Cohen (Cohen’s d). The d value at the level of 0.2
indicates a minor change, 0.5 an intermediate change and 0.8 a major change. The value of Cohen’s
d ≥ 0.5 is considered practically significant. The practical significance between the groups independent
of the sample size was assessed using the Cohen effect of size. The results were statistically processed
using IBM SPSS Statistics (Version 21 for Windows; IBM, Armonk, NY, USA).
RESULTS
The time spent at the prescribed exercise intensity per week ranged between 90-250 min
(mean 156.8±48.9 min). Walking time ranged between 82 and 233 min (mean 142.8±45.7 min). In
relative description of total exercise time walking ranged from 90.0 % to 93.2 %. The time spent at the
described exercise intensity per week ranged between 90-250 min (mean 156.8±48.9 min).
The weekly exercise energy content per kg BM was in subjects with:
• normal BM 20.40 ± 4.51 kcal∙kg-1 (13.4–25.3 kcal∙kg-1),
• overweight 20.36 ± 3.00 kcal∙kg-1 (15.4–24.5 kcal∙kg-1)
• obese 20.33 ± 3.39 kcal∙kg-1 (17.6–24.0 kcal∙kg-1).
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Table 2. Values of demographic and selected functional after intervention and their changes in % of
starting value of subjects practical and statistical significance of changes upon entry to the study.
Variables
NBM
(1)
OV
(2)
OB
(3)
1-2
1-3
2-3
BM (kg)
73.6±2.0
83.7±2.1
89.6±2.3
* α
** αα
* α
ΔBM (%)
- 6.0±1.9
- 6.9±2.1
- 8.0±2.2
NS
NS
NS
BF (%)
20.2±2.1
25.4±2.4
29.8±2.6
NS
** αα
NS
ΔBF (%)
- 8.6±2.1
- 9.0±2.4
- 9.9±2.7
NS
NS
NS
ECM/BCM
0.80±0.02
0.87±0.02
0.94±0.03
* α
** αα
** αα
ΔBCM/ECM (%)
- 6.2±1.7
- 6.6±1.9
- 7.4±2.0
NS
** αα
NS
VO2peak.kg-1 (ml.kg-1.min-1) - BM
36.5±2.4
33.8±2.4
29.4±2.7
NS
* α
NS
ΔVO2peak.kg-1 (%)
+ 10.3±2.2
+ 11.9±2.4
+ 12.7±2.6
NS
NS
NS
VO2peak.kg-1 (ml.kg-1.min-1) - FFM
45.4±2.6
44.8±2.3
43.9±2.7
NS
NS
NS
ΔVO2peak.kg-1 (%)
+ 10.0±2.4
+ 11.1±2.3
+ 12.2±2.7
NS
NS
NS
NBM – normal body mass, OV – overweight, OB – obesity, BCM – body cell mass, ECM – extracellular mas *p<0.05,
**p<0.05, α d=0.5, αα d=0.6
The differences in the energy intensity of the implemented walking-based exercise program
are independent of the weight status of the followed men. The values of functional and anthropometric
parameters in individuals with normal weight are practically identical to the values of untrained Czech
men [23,24]. The values in overweight or obese men are fundamentally affected by their body mass
and differ significantly from the values of individuals with normal body mass. If we convert the values
of oxygen consumption to kg FFM, then we find insignificant differences between the monitored
groups. Changes in demographic and selected functional data in % of starting value of subjects upon
entry to the study are presented in Table 2.
The mean differences in the values of the ECM/BCM coefficient signal different movement
assumptions in men with different body mass§ which reflects their movement regime before the start
of the movement intervention. On the other hand, the changes in these ECM/BCM assumptions are the
same in relative terms due to exercise intervention and are independent of individual weights.
The mean differences between the monitored anthropometric parameters and oxygen
consumption related to kg BM or FFM in our groups of men differ insignificantly (p<0.05, d = 0.6) if the
changes are expressed in % of pre-intervention values. When comparing extreme individuals in weight
groups, the differences may be significant (p<0.05, d = 0.5). The differences in the monitored variables
due to the implemented movement intervention in absolute values are practically the same as in the
pre-intervention parameters.
DISCUSSION
Worse results of anthropometric and functional parameters in individuals with increased
weight are largely due to their weight status, which is a consequence of their inadequate exercise
regime. Diminished daily physical activity explains, in part, why obesity have become worldwide
epidemics. In particular, chair use has replaced ambulation, so that obese individuals tend to sit for
approximately 2.5 h/day more than lean counterparts [9,25].
From activities carried out by overweight or obese individuals walking was the most
preferred/enjoyed activity for both men and women [14]. Otherwise, the other preferred PA were
cycling, swimming and rowing in the Baillot et al. study [26], and dance or Zumba, cycling, water
activities, and martial arts in the Joseph et al. [14] study which was performed among women with
obesity. The preference for physical activities in these individuals is also determined by what physical
activities they have personal experience with, or which PAs they implemented at a time when they
were not overweight or obese. Resistance training was less often identified as a preferred type of PA in
women but more in men [14].
Walking exercise appears to be an effective exercise, and an active walking program had
positive effect on the level of obesity, and significantly reduced body weight, body fat and waist
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circumference [27]. Also, walking exercise contributed to reductions in body weight and body fat by
increasing muscle tissue, maintaining muscular strength and increasing flexibility [28].
The largest changes in preintervention values of VO2peak due to applied movement training are
found in obese individuals (12.7 ± 2.6%). This is consistent with the original results of Dempsey et al.
[29], which reported in a cross-sectional study that as the workload increased, oxygen consumption
increased more rapidly in obese than in lean subjects, leading to the decreased efficiency in obese
subjects. Although the activity type and measurement methodology are different from our study.
These reports support our present findings, which suggest that walking serves as an effective
exercise for overweight and obese individuals with low movement experience. Therefore, continuous
and systematic implementation of such an exercise program is needed.
Increased abdominal fat, among the various criteria used to evaluate obesity, is known to
result in decreased balance as it negatively affects flexibility while shifting the musculoskeletal
structure [28]. Obesity tends to cause arching of the affected individual’s back, and increased stress on
the muscles surrounding the spine can result in back pain). Subsequent postural instability can also
lead to low back pain and diminished flexibility, and the resulting limited range of motion can lead to
secondary inactivity and obesity [9]. The main goal of obesity management is to decrease the size of
the fat tissues while minimizing the effects on FFM. Cardiovascular exercise is known to be the very
effective at decreasing the amount of accumulated fat by utilizing fat as fuel to produce energy.
Walking exercise, like many other cardio exercises, improves cardio-respiratory endurance and
increases secretion of growth hormones (epinephrine and nor-epinephrine), which are known to
promote loss of accumulated fat.
Assumption changes for PA assessed using the ECM/BCM coefficient are greatest in absolute
terms for overweight individuals. This is probably due to the lower volume of spontaneous PA in obese
individuals compared to individuals with better weight status. These individuals usually solve the
necessary daily activities more often by using a car, for example, than individuals with lower body
mass status. It turns out that a sedentary lifestyle is directly proportional to weight and an active
lifestyle is very rare in these people [23,26,27].
On the other hand, the current fitness assessed using the VO2peak kg of FFM is practically
independent of the weight status of the person, although there is evidence of lower muscle mass in the
literature as a result of lower PA. At the same time, it should be recalled that the necessary physical
activities performed represent a greater burden on the muscular system of overweight or obese
individuals, which is probably reflected by a larger volume of muscle mass compensating for
insufficient physical activity, as represented by oxygen consumption values per kg FFM.
Changes in the ECM/BCM coefficient depending on the applied exercise mode show that
walking is not only a means of weight reduction, but that at the same time the predispositions for
exercise load are also improving - ECM/BCM is moving significantly lower. Our obese patients
presented a functional performance similar to healthy individuals. In previous studies, morbid obese
individuals presented functional capacity similar to elderly population [29] or to patients with cardiac
and pulmonary diseases [30-32].
Brisk walking is a recommended form of exercise for obese individuals. However, lower-
extremity joint loads and the associated risk of musculoskeletal injury or pathological disease increase
with walking speed. Walking uphill at a slower speed is an alternative form of moderate intensity
exercise that may reduce joint loading. These results suggest that walking at a relatively slow speed up
a moderate incline is a potential exercise strategy that may reduce the risk of musculoskeletal
injury/pathological disease while providing proper cardiovascular stimulus in obese adults.
Walking on an incline at a relatively slow speed is not a common exercise recommendation for
obese adults and this may be due to the lack of research on the effects of slow walking speeds and
inclines on the biomechanics of walking in this population. In fact, there has only been limited research
on the biomechanics of incline walking in non-obese adults, and no studies have examined the
combined effects of speed and grade.
Walking is the simplest, most accessible, and preferred method of physical activity prescribed
for the treatment and prevention of obesity [27,33]. Additionally, it is important to make walking part
of a lifestyle change and incorporate it into daily activities, such as using it as a form of commuting.
Exercising in groups also is the preferred method of support to increase physical activity among
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inactive adults [14]. Though participation rate for our initial pilot project was low, 98% of participants
stated that they would use the walking buses again, suggesting that these types of programs may be a
viable way to increase physical activity among overweight and obese individuals.
Walking is a popular and comfortable form of physical activity and is part of an effective weight
management strategy for obese individuals [14] that increases energy expenditure associated with
daily leisure activities. However, the higher energy costs for walking (energy expenditure per unit of
distance associated with walking movements) reported in obese individuals compared to lean
individuals [31] may contribute to impaired mobility due to fatigue, and thus reduce the energy
expenditure of free movements. Experiencing daily activities [ie thermogenesis of untrained activities]
and reducing the effectiveness of walking weight management programs.
When recommending exercise for adults with overweight or obesity, it is important to balance
any positive with potential negative effects on health. In the general population, exercise is associated
with an increased risk of musculoskeletal injuries and adverse cardiac events, but there is evidence
from non-randomized trials and observational studies that the benefits of exercise far outweigh the
risks in most adults [34]. Musculoskeletal injuries are the most frequent negative side effects of
exercise. There is however very little information on musculoskeletal injuries in adults with
overweight or obesity during exercise interventions.
To reduce the risk of muscle injuries, it is necessary to provide quality footwear for physical training of
individuals with higher body mass. At the same time, it is necessary to pay attention to the walking
technique, which is usually not good [35,36] especially for individuals with physical deficits and
weight gain, and contributes to faster onset of fatigue, which leads to premature termination of
physical intervention and demotivation of individuals for regular physical training.
It is likely that a larger percentage of adults with overweight or obesity falls in physically
inactive group compared to lean subjects. On the other hand, the largest benefits on all-cause mortality
are attained when this group is moved to an at least “moderately active” level [6,37]. By analogy with
the general population, overall it seems prudent to advise habitually inactive adults with obesity to
become more active by a gradual progression of exercise volume by adjusting exercise duration,
frequency, and/or intensity [35,36,38].
Body mass management, lack of motivation and pain are important PA motives and barriers in
people with obesity. PA motives and barriers are both weight and non-weight related in people with
obesity. For this reason, weight loss cannot be the only solution to remove PA barriers, and these
should be addressed in PA interventions with the support of health professionals to facilitate PA
initiation and maintenance. Further research is needed to investigate the PA preferences of people
with obesity. Although, one size intervention does not fit all, the improvement of knowledge on PA
barriers, motives and preferences would help health professionals to better address them, and develop
intervention to reach the larger number of people with obesity in order to decrease physical inactivity
in this population.
Study limits
The limits of the study include a limited number of subjects, which makes it impossible to
generalize the conclusions. Another limit is that not all men completed the intervention on the same
date, some in the spring and others in the fall. The information on the overall exercise regime was
evaluated only by questioning and could be inaccurately interpreted. They were all tested by the same
instruments on the same day of the week and in the morning.
CONCLUSIONS
We may conclude that, although the groups showed different exercise intensities, but similar
overall energy intensity, which regulate fat oxidation, the changes in all parameters monitored were
similar between the groups. We can conclude that an exercise program with a similar energy content,
form and intensity causes the similar changes in adiposity and in motor and functional performance in
middle age men, differing in BM. Movement intervention based on walking reduces body weight and at
the same time improves the morphological preconditions for physical activity. The study was
supported by grant of Charles University Progress Q 41.
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