Review| Volume 24, ISSUE 12, P1245-1254, December 2021

Download started.


Physical activity in the management of obesity in adults: A position statement from Exercise and Sport Science Australia

Published:August 02, 2021DOI:


      This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300–420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Australian National Preventive Health Agency (ANPHA)
        State of Preventive Health 2013. Report to the Australian Government Minister for Health. Canberra.
      1. Australian Bureau of Statistics. National Health Survey: First Results Canberra 2014–15. Available from:[email protected]/mf/4364.0.55.001.

      2. Organisation for Economic Co-operation and Development (OECD). StatExtracts Non-medical determinants of health 2016. Available from:

        • Australian Institute of Health and Welfare
        Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Canberra.
        • Calderón-Larrañaga A.
        • Hernández-Olivan P.
        • González-Rubio F.
        • et al.
        Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records.
        BMJ Open. 2015; 5 (e006227-e)
        • Obesity WHOCo, World Health O
        Obesity: preventing and managing the global epidemic.
        World Health Organization, Geneva2000 (Report No.: 9789241208949;9241208945; Contract No.: Report)
        • National Health and Medical Research Council (NHMRC)
        Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia.
        NHMRC, Canberra2013
        • Ross R.
        • Neeland I.J.
        • Yamashita S.
        • et al.
        Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on Visceral Obesity.
        Nat Rev Endocrinol. 2020; 16: 177-189
        • Gadde K.M.
        • Martin C.K.
        • Berthoud H.-R.
        • et al.
        J Am Coll Cardiol. 2018; 71: 69
        • Ross R.
        • Bradshaw A.J.
        The future of obesity reduction: beyond weight loss.
        Nat Rev Endocrinol. 2009; 5: 319-325
        • Butland B.J.S.
        • Kopelman P.
        • McPherson K.
        • et al.
        Tackling Obesities: Future Choices - Project Report.
        Government Office for Science, UK2007
        • Lee A.
        • Cardel M.
        • Donahoo W.T.
        Social and environmental factors influencing obesity.
        in: Feingold K.R. Anawalt B. Boyce A. Chrousos G. Dungan K. Grossman A. Endotext., Inc., South Dartmouth (MA)2000
        • Sumithran P.
        • Proietto J.
        The defence of body weight: a physiological basis for weight regain after weight loss.
        Clin Sci (London, England : 1979). 2013; 124: 231-241
        • Pontzer H.
        • Durazo-Arvizu R.
        • Dugas L.R.
        • et al.
        Constrained Total energy expenditure and metabolic adaptation to physical activity in adult humans.
        Curr Biol. 2016; 26: 410-417
        • McGuire M.T.
        • Wing R.R.
        • Hill J.O.
        The prevalence of weight loss maintenance among American adults.
        Int J Obes (Lond). 1999; 23: 1314-1319
        • Weiss E.C.
        • Galuska D.A.
        • Kettel Khan L.
        • et al.
        Weight regain in U.S. adults who experienced substantial weight loss, 1999–2002.
        Am J Prev Med. 2007; 33: 34-40
        • Slentz C.A.
        • Bateman L.A.
        • Willis L.H.
        • et al.
        Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT.
        Am J Physiol Endocrinol Metabol. 2011; 301: 1033-1039
        • Neeland I.J.
        • Ross R.
        • Després J.P.
        • et al.
        Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement.
        Lancet Diabetes Endocrinol. 2019; 7: 715-725
        • Verheggen R.J.
        • Maessen M.F.
        • Green D.J.
        • et al.
        A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue.
        Obes Rev. 2016; 17: 664-690
        • Patel P.
        • Abate N.
        Role of subcutaneous adipose tissue in the pathogenesis of insulin resistance.
        J Obes. 2013; 2013: 489187
        • Elagizi A.
        • Kachur S.
        • Carbone S.
        • et al.
        A review of obesity, physical activity, and cardiovascular disease.
        Curr Obes Rep. 2020; 9: 571-581
        • Petridou A.
        • Siopi A.
        • Mougios V.
        Exercise in the management of obesity.
        Metabolism. 2019; 92: 163-169
        • Chaston T.B.
        • Dixon J.B.
        Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review.
        Int J Obes (Lond). 2008; 32: 619-628
        • Snel M.
        • Jonker J.T.
        • Schoones J.
        • et al.
        Ectopic fat and insulin resistance: pathophysiology and effect of diet and lifestyle interventions.
        Int J Endocrinol. 2012; 2012: 983814
        • Donnelly J.E.
        • Blair S.N.
        • Jakicic J.M.
        • et al.
        Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults.
        Med Sci Sports Exerc. 2009; 41: 459-471
        • Klein S.
        • Allison D.B.
        • Heymsfield S.B.
        • et al.
        Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association.
        Am J Clin Nutr. 2007; 85: 1197-1202
        • Brown W.J.B.A.
        • Bull F.C.
        • Burton N.W.
        Development of Evidence-based Physical Activity Recommendations for Adults (18–64 years).
        Commonwealth of Australia, 2013 (Report No.: 978-1-74186-070-2)
        • Physical Activity Guidelines Advisory Committee
        Physical Activity Guidelines Advisory Committee Report.
        Department of Health and Human Services, Washington, DC. United States2008 (Contract No.: 2)
        • World Health Organization
        Global recommendations on physical activity for health.
        WHO, Geneva2010
        • Gomersall S.R.
        • Dobson A.J.
        • Brown W.J.
        Weight gain, overweight, and obesity: determinants and health outcomes from the Australian Longitudinal Study on Women’s Health.
        Curr Obes Rep. 2014; 3: 46-53
        • Dobson A.
        • Hockey R.
        • Chan H.-W.
        • et al.
        Flexible age-period-cohort modelling illustrated using obesity prevalence data.
        BMC Med Res Methodol. 2020; 20: 16
        • Peters J.C.
        • Beck J.
        • Cardel M.
        • et al.
        The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: a randomized clinical trial.
        Obesity. 2016; 24: 297-304
        • U.S. Department of Health and Human Services
        2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC.
        • Fogelholm M.
        • Kukkonen-Harjula K.
        Does physical activity prevent weight gain — a systematic review.
        Obes Rev. 2000; 1: 95-111
        • Shaw K.
        • Gennat H.
        • O’Rourke P.
        • et al.
        Exercise for overweight or obesity.
        Cochrane Database Syst Rev. 2006; 4CD003817
        • Summerbell C.D.
        • Douthwaite W.
        • Whittaker V.
        • et al.
        The association between diet and physical activity and subsequent excess weight gain and obesity assessed at 5 years of age or older: a systematic review of the epidemiological evidence.
        Int J Obes (Lond). 2009; 33: S1
        • Wareham N.J.
        • van Sluijs E.M.F.
        • Ekelund U.
        Physical activity and obesity prevention: a review of the current evidence.
        Proc Nutrition Soc. 2005; 64: 229-247
        • Wareham N.
        Physical activity and obesity prevention.
        Obes Rev. 2007; 8: 109-114
      3. Commonwealth Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines Canberra, Australia 2014. Available from:

        • Jakicic M.J.
        • Powell E.K.
        • Campbell W.W.
        • et al.
        Physical activity and the prevention of weight gain in adults: a systematic review.
        Med Sci Sports Exerc. 2019; 51: 1262-1269
        • Swift D.L.
        • McGee J.E.
        • Earnest C.P.
        • et al.
        The effects of exercise and physical activity on weight loss and maintenance.
        Prog Cardiovasc Dis. 2018; 61: 206-213
        • Shephard R.J.
        Limits to the measurement of habitual physical activity by questionnaires.
        Br J Sports Med. 2003; 37: 197
        • Slentz C.A.
        • Aiken L.B.
        • Houmard J.A.
        • et al.
        Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount.
        J Appl Physiol (Bethesda, Md : 1985). 2005; 99: 1613-1618
      4. SIGN (Scottish Intercollegiate Guidelines Network). Management of obesity. A national clinical guideline Edinburgh: SIGN; 2010 [115:[Available from:

        • O’Donoghue G.
        • Blake C.
        • Cunningham C.
        • et al.
        What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta-analysis.
        Obes Rev. 2020; 22e13137
        • Jeffery R.W.
        • Wing R.R.
        • Sherwood N.E.
        • et al.
        Physical activity and weight loss: does prescribing higher physical activity goals improve outcome?.
        Am J Clin Nutr. 2003; 78: 684-689
        • Jakicic J.M.
        Physical activity and weight loss. Chap 2.
        in: Drewnowski A. Rolls B.J. Obesity Treatment And Prevention: New Directions. Karger, Basel2012
        • Kim H.
        • Reece J.
        • Kang M.
        Effects of accumulated short bouts of exercise on weight and obesity indices in adults: a meta-analysis.
        Am J Health Promot. 2019; 34: 96-104
        • Ohkawara K.
        • Tanaka S.
        • Miyachi M.
        • et al.
        A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials.
        Int J Obes (Lond). 2007; 31: 1786-1797
        • Vissers D.
        • Hens W.
        • Taeymans J.
        • et al.
        The effect of exercise on visceral adipose tissue in overweight adults: a systematic review and meta-analysis.
        PLoS One. 2013; 8 (e56415-e)
        • Church T.S.
        • Martin C.K.
        • Thompson A.M.
        • et al.
        Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women.
        PLoS One. 2009; 4e4515
        • Ross R.
        • Hudson R.
        • Stotz P.J.
        • et al.
        Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: a randomized trial.
        Ann Intern Med. 2015; 162: 325-334
        • Keating S.E.
        • Johnson N.A.
        • Mielke G.I.
        • et al.
        A systematic review and meta-analysis of interval training versus moderate-intensity continuous training on body adiposity.
        Obes Rev. 2017; 18: 943-964
        • Winn N.C.
        • Liu Y.
        • Rector R.S.
        • et al.
        Energy-matched moderate and high intensity exercise training improves nonalcoholic fatty liver disease risk independent of changes in body mass or abdominal adiposity — a randomized trial.
        Metabolism. 2018; 78: 128-140
        • Viana R.B.
        • Naves J.P.A.
        • Coswig V.S.
        • et al.
        Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT).
        Br J Sports Med. 2019; 53: 655-664
        • Baker C.J.
        • Martinez-Huenchullan S.F.
        • D’Souza M.
        • et al.
        Effect of exercise on hepatic steatosis: are benefits seen without dietary intervention? A systematic review and meta-analysis.
        J Diabetes. 2020; 13: 63-77
        • Boutcher S.H.
        High-intensity intermittent exercise and fat loss.
        J Obes. 2011; 2011
        • Viana R.B.
        • Naves J.P.
        • Coswig V.S
        • et al.
        Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT).
        Br J Sports Med. 2019; 53: 655-664
        • Su L.
        • Fu J.
        • Sun S.
        • et al.
        Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: a meta-analysis..
        PLoS One. 2019; 14e0210644
        • Sultana R.N.
        • Sabag A.
        • Keating S.E.
        • et al.
        The effect of low-volume high-intensity interval training on body composition and cardiorespiratory fitness: a systematic review and meta-analysis.
        Sports Med. 2019; 49: 1687-1721
        • Wewege M.A.
        • van den Berg R.
        • Ward R.E.
        • et al.
        High-intensity interval training vs. moderate-intensity continuous training for body composition. a systematic review and meta-analysis: 1426 Board #101 June 1 9.
        Med Sci Sports Exerc. 2017; 49: 393
        • Keating S.E.
        • Hackett D.A.
        • George J.
        • et al.
        Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis.
        J Hepatol. 2012; 57: 157-166
        • Dunstan D.W.
        • Daly R.M.
        • Owen N.
        • et al.
        High-intensity resistance training improves glycemic control in older patients with type 2 diabetes.
        Diabetes Care. 2002; 25: 1729-1736
        • Frimel T.N.
        • Sinacore D.R.
        • Villareal D.T.
        Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults.
        Med Sci Sports Exerc. 2008; 40: 1213-1219
        • Ismail I.
        • Keating S.E.
        • Baker M.K.
        • et al.
        A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat.
        Obes Rev. 2012; 13: 68-91
        • Sabag A.
        • Way K.L.
        • Keating S.E.
        • et al.
        Exercise and ectopic fat in type 2 diabetes: a systematic review and meta-analysis.
        Diabetes Metab. 2017; 43: 195-210
        • Frimel N.T.
        • Sinacore R.D.
        • Villareal T.D.
        Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults.
        Med Sci Sports Exerc. 2008; 40: 1213-1219
        • Geary N.
        Control-theory models of body-weight regulation and body-weight-regulatory appetite.
        Appetite. 2020; 144104440
        • Hall K.D.
        • Sanghvi A.
        • Göbel B.
        Proportional feedback control of energy intake during obesity pharmacotherapy.
        Obesity (Silver Spring). 2017; 25: 2088-2091
        • Schoeller D.A.
        • Shay K.
        • Kushner R.F.
        How much physical activity is needed to minimize weight gain in previously obese women?.
        Am J Clin Nutr. 1997; 66: 551-556
      5. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr 2005;82(1 Suppl):222S–5S.

        • Flack K.D.
        • Ufholz K.
        • Johnson L.
        • et al.
        Energy compensation in response to aerobic exercise training in overweight adults.
        Am J Physiol Regul Integr Comp Physiol. 2018; 315: R619-r26
        • Saris W.H.M.
        • Blair S.N.
        • van Baak M.A.
        • et al.
        How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement.
        Obes Rev. 2003; 4: 101-114
        • Jakicic J.M.
        • Powell K.E.
        • Campbell W.W.
        • et al.
        Physical activity and the prevention of weight gain in adults: a systematic review.
        Med Sci Sports Exerc. 2019; 51: 1262-1269
        • Jakicic J.M.
        • Kraus W.E.
        • Powell K.E.
        • et al.
        Association between bout duration of physical activity and health: systematic review.
        Med Sci Sports Exerc. 2019; 51: 1213-1219
        • Jakicic J.M.
        • Marcus B.H.
        • Gallagher K.I.
        • et al.
        Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial.
        JAMA. 2003; 290: 1323-1330
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Laaksonen D.E.
        • Lindström J.
        • Lakka T.A.
        • et al.
        Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study.
        Diabetes. 2005; 54: 158-165
        • McTiernan A.
        • Sorensen B.
        • Irwin M.L.
        • et al.
        Exercise effect on weight and body fat in men and women.
        Obesity. 2007; 15: 1496-1512
        • Tate D.F.
        • Jeffery R.W.
        • Sherwood N.E.
        • et al.
        Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain?.
        Am J Clin Nutr. 2007; 85: 954-959
        • Tuomilehto J.
        • Lindström J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001; 344: 1343-1350
        • Maillard F.
        • Pereira B.
        • Boisseau N.
        Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis.
        Sports Med. 2018; 48: 269-288
        • Lunt H.
        • Draper N.
        • Marshall H.C.
        • et al.
        High intensity interval training in a real world setting: a randomized controlled feasibility study in overweight inactive adults, measuring change in maximal oxygen uptake.
        PLoS One. 2014; 9e83256
        • Miller C.T.
        • Fraser S.F.
        • Levinger I.
        • et al.
        The effects of exercise training in addition to energy restriction on functional capacities and body composition in obese adults during weight loss: a systematic review.
        PLoS One. 2013; 8e81692
        • Andreato L.V.
        • Esteves J.V.
        • Coimbra D.R.
        • Moraes A.J.P.
        • de Carvalho T.
        The influence of high-intensity interval training on anthropometric variables of adults with overweight or obesity: a systematic review and network meta-analysis.
        Obes. Rev. 2019; 20 (10.1111/obr.12766): 142-155
        • Henness S.
        • Perry C.M.
        Orlistat: a review of its use in the management of obesity.
        Drugs. 2006; 66: 1625-1656
        • Davies M.J.
        • Bergenstal R.
        • Bode B.
        • et al.
        Efficacy of Liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial.
        JAMA. 2015; 314: 687-699
        • O’Brien P.E.
        • Brown W.A.
        • Dixon J.B.
        Obesity, weight loss and bariatric surgery.
        Med J Aust. 2005; 183: 310-314
        • Tewksbury C.
        • Williams N.N.
        • Dumon K.R.
        • et al.
        Preoperative medical weight management in bariatric surgery: a review and reconsideration.
        Obes Surg. 2017; 27: 208-214
        • Egberts K.
        • Brown W.A.
        • Brennan L.
        • et al.
        Does exercise improve weight loss after bariatric surgery? A systematic review.
        Obes Surg. 2012; 22: 335-341
        • Hoffmann T.C.
        • Maher C.G.
        • Briffa T.
        • et al.
        Prescribing exercise interventions for patients with chronic conditions.
        Can Med Assoc J. 2016; 188: 510-518
        • Han T.S.
        • Tajar A.
        • Lean M.E.J.
        Obesity and weight management in the elderly.
        Br Med Bull. 2011; 97: 169-196
        • Sharma A.
        • Lavie C.J.
        • Borer J.S.
        • et al.
        Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure.
        Am J Cardiol. 2015; 115: 1428-1434
        • Rejeski W.J.
        • Focht B.C.
        • Messier S.P.
        • et al.
        Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.
        Health Psychol. 2002; 21: 419-426
        • Anandacoomarasamy A.
        • Fransen M.
        • March L.
        Obesity and the musculoskeletal system.
        Curr Opin Rheumatol. 2009; 21: 71-77
        • Izquierdo M.
        • Merchant R.A.
        • Morley J.E.
        • et al.
        International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines.
        J Nutr Health Aging. 2021; 25: 824-853