Introduction: The benefits of exercise in patients with obesity are clear; physical performance and quality of life improve after exercise programs in patients with obesity. Our aim was to evaluate the usefulness of an easy, structured, and home-based exercise program to improve physical performance and quality-of-life in patients with obesity. Methods: A cohort of patients with obesity (BMI ≥30 kg/m2) was recruited during 2017–2020. Patients who met the inclusion criteria were invited and those who accepted signed informed consent. Patients were evaluated by the same team of physicians who performed the 6-min walking test and collected the clinical and biochemical variables, also applied quality-of-life questionnaire at baseline and 3 months after starting the exercise program that was divided in two levels: level 1: active mobilization of four limbs (15 min) + cardiovascular exercise (15 min walking), 5 days/week; level 2: eight strengthening exercises for upper and lower limbs with an elastic band + cardiovascular exercise (15 min walking), 5 days/week. This study used means (SD), frequencies (percent), Student's t test, and Pearson correlation test. Results: We included 151 patients, mostly women (81.5%), age 46.3 ± 9.8 years old, BMI 40.3 ± 8.56 kg/m2, 34.4% performed some type of exercise, and the most frequents comorbidities were dyslipidemia and diabetes. After 3 months, 86 patients (57%) remained in the study and attended the final evaluation. Evident changes in physical performance were reported (distance traveled, speed walking and VO2max); however, improvement in quality of life was remarkable. Conclusion: An easy, structured, and home-based exercise program improves physical performance and quality of life in patients with obesity, without losing its benefits for the health.

According to the World Health Organization, there are more than 1,900 million adults with overweight, with 650 million adults (13%) classified as having obesity (body mass index, BMI, ≥30 kg/m2) in 2016 [1]. Obesity is considered an epidemic and a major health problem because it is associated with increased prevalence of other health conditions, including cardiovascular disease (CV), diabetes mellitus, and hypertension, as well as increased CV mortality [2]. In addition, obesity has been shown to have negative impacts on quality of life, self-esteem, and psychosocial well-being. Fortunately, currently more therapeutic tools are available that help to improve comorbidities, promote weight loss and, therefore, improve the quality of life in people with overweight and obesity [3, 4].

People with overweight and obesity could obtain the irrefutable and substantial benefits of regular physical activity [5]. Beyond its beneficial effects on body weight and adiposity, physical activity and regular exercise lowers the risks of developing CV disease, type 2 diabetes mellitus, depression, anxiety and improves functionality in patients with obesity [6]. Nevertheless, there are barriers that interfere in the exercise adherence in patients with obesity, including poor motivation, a lack of time, environmental and social pressures, health, and physical limitations, socioeconomic constraints, and a lack of enjoyment [7].

Current guidelines for the treatment of overweight and obesity advise comprehensive lifestyle interventions (exercise and low-calorie diets) to promote the decrease of body fat and increase lean mass. These interventions should be included in a program of multidisciplinary treatment, even if the patient will be treated with bariatric surgery before and after their treatment [8].

Exercise benefits in patients with obesity are clear; however, adherence is hard. It is necessary to design an easy, structured, and home-based exercise program to promote adherence in patients with obesity. In this study, we aimed to evaluate the usefulness of an easy, structured, home-based exercise program to improve physical performance and quality of life in a patient’s cohort with obesity.

This prospective and longitudinal study included patients with obesity from the cohort at the Obesity Clinic Department, Hospital General de México "Dr. Eduardo Liceaga" in Mexico City, during the period of 2017–2020. Accepted patient were consecutive patients with obesity: BMI, ≥30 kg/m2, with chronic diseases under supervision, and without complicated CVs such as recent ischemic heart disease, heart failure, or intermittent claudication, without orthopedic conditions that contraindicate performing exercise (fractures, severe osteoarthritis in knees, hips, or spine; rotator cuff injuries or recent sprains), recent surgeries (including recent bariatric surgery) or cognitive impairments that make it difficult to understand and follow the exercise program. Patients unable to tolerate the physical performance evaluation were eliminated from the study. A specialist evaluated each of the studied areas, an endocrinologist evaluated the biochemical variables, a nutritionist recorded the anthropometric changes, and a physiatrist performed the physical performance test. All tests were performed in a baseline evaluation and 3 months later. Patients who met the inclusion criteria were invited and those who accepted signed informed consent. After the first clinical evaluation, 151 patients were included in the cohort and 86 (57%) attended for clinical evaluation 3 months later. This project was approved by IRB at our hospital (ID project: DI/17/402/3/009).

Physical Performance

The physical performance was evaluated with the 6-minute walk test (6MWT), which was performed in an indoor 20 m corridor, following the American Thoracic Society’s recommendations [9]. The subjects were instructed to walk the longest distance possible in 6 min. After 6 minutes, the walked distance was measured to the nearest meter by the physiatrist. Before and after the test, heart rate and SpO2 were measured. The distance covered (6MWD = 6 minutes Walking Distance) during the 6MWT was also estimated using the predictive equation developed by Capodaglio et al. [10] The proposed reference equation is: 6MWTm=894.21772.0700×ageyears51.4489×gendermales=0;females=15.1663×BMIkg/m2. This test has been proven to be highly reproducible in patients with obesity, even with several degrees of obesity [11, 12].

In addition, the maximal aerobic power (VO2max) was calculated using the following formula:

  • VO2max(mL·kg1·min1)=26.9+0.014×6MWD0.38×BMI

where 6MWD is distance walked in 6 min (m) and BMI is calculated body mass index (kg/m2) [13].

Biochemical Variables

Blood chemistry was analyzed including glucose, urea, creatinine, uric acid, glycated hemoglobin, glucose tolerance curve, lipids (cholesterol, high-density lipoproteins, very-low-density lipoproteins, low-density lipoproteins, and triglycerides), and albumin.

Anthropometric and Body Composition Evaluations

To conduct a body composition assessment and anthropometric evaluation, the nutritionist performed the anthropometric evaluation, which included weight, height, BMI, waist and hips circumference, waist-hip index, and bioelectrical impedance analysis (TANITA* Model SX-331S).

Quality of Life Assessment

All patients answered the Impact of Weight in Quality of Life – lite (IWQOL) questionnaire that comprises 30 items organized by domains (physical function [11 items], self-esteem [7 items], sexual life [4 items], public distress [4 items], and work [4 items]), with scores ranging from 30 to 150, with 150 representing the worst quality of life [14]. This questionnaire has been validated in Spanish and has proven to be a reliable and sensitive tool that can be used for research purposes in Mexico and the Latin America region [15].

Home-Based Exercise Program

All patients were instructed to perform a structured and easy home-based exercise program divided into two levels:

  • Level 1: patient started with active mobilizations of four limbs (15 min) and cardiovascular exercise at intervals of 1 min (fast) and 3 min (slow) (15 min walking), 5 days per week.

  • Level 2: strengthening exercise of four limbs with elastic resistance bands using only the red (3.7 lbs) and green (4.6 lbs) colors [16]. The routine comprised four exercises for the upper limbs (biceps, triceps, deltoids, and chest muscles) and four exercises for the lower limbs (quadriceps, gluteus, hamstrings, and triceps sural), executed in three sets with 10 repetitions for every exercise. In addition, the exercise program was complemented with cardiovascular exercise in intervals (1 min fast and 3 min slow) during 15 min walking, 5 days per week.

All patients received teaching sessions for the three exercise routines and were instructed to calculate the intensity at 65% of their maximum heart rate (maxHR). The maxHR was obtained for each subject by subtracting the age from 220 [17].

Statistical Analysis

Demographic and clinical variables were reported using descriptive statistics means ± standard deviation for continuous variables and proportions for dichotomic or nominal variables. The study used the Student's t test to compare the baseline and final evaluations. Also, Pearson correlation was performed between physical performance variables and quality of life questionnaire scores. The statistical significance level was 0.05 (both sides) using statistical package SPSS for MAC version 20.

All patients were referred to the rehabilitation department to start the exercise program during the period spanning 2017–2020 that complied with the acceptance criteria were invited and all that accepted were included in this study. One hundred fifty-one patients were included in the follow-up cohort and received the baseline evaluations. Most patients were female (81.5%; n = 123), whose main activities were stay-at-home parent (40.4%; n = 61) and merchants (15.2%; n = 23), with mean age 46.3 ± 9.8 years old, weight 100.8 ± 24.3 kg, height 1.6 ± 0.1 m, and BMI 40.3 ± 8.56 kg/m2. Only 52 (34.4%) patients performed some type of exercise, with walking the most popular (20.5%; n = 31). The most frequent comorbidities were diabetes mellitus and dyslipidemia (64.9%; n = 98 each one), knee arthrosis and hypertension (41.7%; n = 63 each one), and spine arthrosis (23.2%; n = 35). Fifteen patients (10%) received bariatric surgery at least 6 months before the study. After 3 months, 86 patients (57%) remained in the study and attended the final evaluation.

Changes between Baseline and Final Evaluation after Three Months Follow-Up

After 3 months, several changes in anthropometric variables were found. The greatest changes were observed in weight (101.3 ± 32.5 vs. 91.2 ± 24.3 kg; p < 0.01), showing a 10% reduction, along with BMI (41.2 ± 9.7 vs. 37.3 ± 8.4 kg/m2; p < 0.01), waist (120.4 ± 22.2 vs. 110.3 ± 18.4 cm; p < 0.01), and hip circumference differences (129.8 ± 19.2 vs. 123.1 ± 17.7 cm; p < 0.01).

On the other hand, we found changes in the distance traveled during the physical evaluation, with an increase in the distance traveled before and after the follow-up (430 ± 69.7 vs. 481.2 ± 68.8; p < 0.01), while there was also a change in walking speed (m/min traveled = 71.8 ± 11.6 vs. 80.2 ± 11.5; p < 0.01) these results reflect a 12% improvement in both variables; however, no evaluation was able to achieve values close to the expected distance (predicted distance according to Capodaglio et al.’s [10] equation = 546.7 ± 47.6 m). In addition, changes in HR were found with a slight increase in HR and maxHR after the follow-up test. Also, we found changes in VO2max between the baseline and after the follow-up (17.1 ± 4.0 vs. 19.2 ± 3.8; p = 0.02) (Table 1).

Table 1.

Changes in physical performance, biochemical, anthropometric, and quality of life variables in patients with obesity after 3 months of follow-up

VariableBaseline evaluation (n = 151)Final evaluation (n = 86)p value
Physical performance 
 Distance traveled, m 430.2 (69.7) 481.2 (68.8) <0.01 
 Walking speed, m/min 71.8 (11.6) 80.2 (11.5) <0.01 
 Resting HR, bpm 74.2 (10.8) 75.8 (10.4) 0.31 
 Post-6MWT HR, bpm 113.3 (20.5) 119.1 (14.7) 0.02 
 Post-6MWT maxHR, % 0.65 (0.11) 0.69 (0.07) 0.02 
 VO2max, mL·kg−1·min−1 17.1 (4.0) 19.2 (3.8) <0.01 
 Resting pSO2, % 92.9 (2.6) 93.7 (3.6) 0.08 
Biochemical changes 
 Glucose, mg/dL 104.0 (22.9) 98.1 (12.7) 0.32 
 HbA1, % 5.9 (0.4) 5.6 (0.3) 0.05 
 Urea, mg/dL 27.4 (5.9) 31.9 (11.2) 0.16 
 Creatinine, mg/dL 0.71 (0.11) 0.70 (0.14) 0.58 
 Uric acid, mg/dL 5.5 (1.1) 5.8 (1.8) 0.69 
 Total cholesterol, mg/dL 176.8 (38.3) 166.5 (41.9) 0.22 
 HDL, mg/dL 44.1 (11.1) 45.5 (10.4) 0.42 
 Triglycerides, mg/dL 137.1 (53.2) 145.7 (97.1) 0.70 
 LDL, mg/dL 103.3 (29.7) 93.3 (37.4) 0.27 
Anthropometric variables 
 Weight, kg 101.3 (32.5) 91.2 (24.3) <0.01 
 Height, m 1.57 (0.09) 1.57 (0.09) 0.48 
 BMI, kg/m2 41.2 (9.7) 37.3 (8.4) <0.01 
 Hip circumference, cm 129.8 (19.2) 123.1 (17.7) <0.01 
 Waist circumference, cm 120.4 (22.2) 110.3 (18.4) <0.01 
 Waist/hip index, cm 92.8 (10.1) 89.5 (7.0) 0.07 
Body composition 
 Fat mass, % 43.3 (8.2) 40.8 (9.4) 0.12 
 Fat mass, kg 42.7 (17.6) 37.1 (14.7) 0.05 
 Lean mass, kg 52.6 (8.6) 51.3 (8.6) 0.04 
 Muscular mass, kg 49.8 (8.2) 48.7 (8.2) 0.65 
Impact of weight in quality of life – lite (IWQOL) 
 Physical function (score) 35.9 (10.2) 25.9 (10.4) <0.01 
 Self-esteem (score) 21.1 (8.9) 13.7 (7.3) <0.01 
 Sexual life (score) 9.7 (5.4) 7.6 (5.2) 3.88 
 Public distress (score) 13.0 (6.4) 9.3 (5.7) 0.02 
 Work (score) 8.9 (4.6) 6.7 (4.0) 0.09 
 Global score 88.5 (29.8) 63.4 (29.3) <0.01 
VariableBaseline evaluation (n = 151)Final evaluation (n = 86)p value
Physical performance 
 Distance traveled, m 430.2 (69.7) 481.2 (68.8) <0.01 
 Walking speed, m/min 71.8 (11.6) 80.2 (11.5) <0.01 
 Resting HR, bpm 74.2 (10.8) 75.8 (10.4) 0.31 
 Post-6MWT HR, bpm 113.3 (20.5) 119.1 (14.7) 0.02 
 Post-6MWT maxHR, % 0.65 (0.11) 0.69 (0.07) 0.02 
 VO2max, mL·kg−1·min−1 17.1 (4.0) 19.2 (3.8) <0.01 
 Resting pSO2, % 92.9 (2.6) 93.7 (3.6) 0.08 
Biochemical changes 
 Glucose, mg/dL 104.0 (22.9) 98.1 (12.7) 0.32 
 HbA1, % 5.9 (0.4) 5.6 (0.3) 0.05 
 Urea, mg/dL 27.4 (5.9) 31.9 (11.2) 0.16 
 Creatinine, mg/dL 0.71 (0.11) 0.70 (0.14) 0.58 
 Uric acid, mg/dL 5.5 (1.1) 5.8 (1.8) 0.69 
 Total cholesterol, mg/dL 176.8 (38.3) 166.5 (41.9) 0.22 
 HDL, mg/dL 44.1 (11.1) 45.5 (10.4) 0.42 
 Triglycerides, mg/dL 137.1 (53.2) 145.7 (97.1) 0.70 
 LDL, mg/dL 103.3 (29.7) 93.3 (37.4) 0.27 
Anthropometric variables 
 Weight, kg 101.3 (32.5) 91.2 (24.3) <0.01 
 Height, m 1.57 (0.09) 1.57 (0.09) 0.48 
 BMI, kg/m2 41.2 (9.7) 37.3 (8.4) <0.01 
 Hip circumference, cm 129.8 (19.2) 123.1 (17.7) <0.01 
 Waist circumference, cm 120.4 (22.2) 110.3 (18.4) <0.01 
 Waist/hip index, cm 92.8 (10.1) 89.5 (7.0) 0.07 
Body composition 
 Fat mass, % 43.3 (8.2) 40.8 (9.4) 0.12 
 Fat mass, kg 42.7 (17.6) 37.1 (14.7) 0.05 
 Lean mass, kg 52.6 (8.6) 51.3 (8.6) 0.04 
 Muscular mass, kg 49.8 (8.2) 48.7 (8.2) 0.65 
Impact of weight in quality of life – lite (IWQOL) 
 Physical function (score) 35.9 (10.2) 25.9 (10.4) <0.01 
 Self-esteem (score) 21.1 (8.9) 13.7 (7.3) <0.01 
 Sexual life (score) 9.7 (5.4) 7.6 (5.2) 3.88 
 Public distress (score) 13.0 (6.4) 9.3 (5.7) 0.02 
 Work (score) 8.9 (4.6) 6.7 (4.0) 0.09 
 Global score 88.5 (29.8) 63.4 (29.3) <0.01 

6MWT, 6 min walking test; HR, heart rate; BMI, body mass index; HDL, high density lipoproteins; LDL, low density lipoprotein.

Shown are means and standard deviation.

Relation between Weight Loss, Quality-of-Life, and Physical Performance (VO2max)

When this project started, the relation between weight and IWQOL-Lite score was low, albeit with a statistical significance (r = 0.320; p < 0.01); however, after follow-up, the relation was even bigger (r = 0.596; p < 0.01), also we found relation between VO2max and IWQOL-Lite at the baseline and the final evaluations, however, there was not relation with the 6MWD. On the other hand, the relation between 6MWD, VO2max and weight is clear at the baseline and final evaluations (Table 2). Also, patients showed an improvement in quality of life after following up in every single IWQOL-Lite domain, except the domains of sexual life and work (p > 0.05) (Table 1).

Table 2.

Relation between quality of life, weight, and physical performance in patients with obesity

IWQOL baselineIWQOL finalWeight baselineWeight final6MWD baseline6MWD final
Weight baseline 0.320 (<0.01)      
Weight final  0.596 (<0.01)     
6MWD baseline −0.091 (0.26)  −0.22 (<0.01)    
6MWD final  −0.242 (0.06)  −0.27 (0.26)   
VO2max baseline −0.36 (<0.01)  −0.81 (<0.01)  0.61 (<0.01)  
VO2max final  −0.56 (<0.01)  −0.78 (<0.01)  0.72 (<0.01) 
IWQOL baselineIWQOL finalWeight baselineWeight final6MWD baseline6MWD final
Weight baseline 0.320 (<0.01)      
Weight final  0.596 (<0.01)     
6MWD baseline −0.091 (0.26)  −0.22 (<0.01)    
6MWD final  −0.242 (0.06)  −0.27 (0.26)   
VO2max baseline −0.36 (<0.01)  −0.81 (<0.01)  0.61 (<0.01)  
VO2max final  −0.56 (<0.01)  −0.78 (<0.01)  0.72 (<0.01) 

IWQOL, impact of weight in quality of life – Lite score; 6MWD, 6 minutes walking distance.

Exercise has been tested like a major therapeutic tool to improve physical performance [18], physical function and quality of life [19] in patients with obesity, and despite low adherence the premise “sometimes little is better than nothing at all” is still true in these patients. The aim of this study was to evaluate the usefulness of an easy-to-implement exercise program that people with obesity could perform at home with the goal of improving their physical performance and quality of life.

After 3 months of follow-up, the patients in the cohort showed improvement in the physical performance variables that include walking speed, distance traveled during the 6MWT and the VO2max, with greater distance traveled, higher walking speed and an increase in VO2max. However, the most important changes were observed in the improvement in quality of life, with significant differences in the IWQOL questionnaire score, mainly in the physical function domain.

Poor physical activity and an unbalanced diet contribute to the obesity epidemic. In addition, patients with obesity show lower levels of quality of life and psychological disturbances. Different types of exercise interventions (aerobic activities, walking, strengthening) have been suggested to improve physical performance and quality of life in these patients [20‒22].

Obesity has a negative impact on the quality of life of those who suffer from it. Weight loss is associated with an improvement in quality of life. Regardless, the medical intervention improvement in physical aspects is more common than in mental/psychosocial aspects [23]. In this study, the participants showed improvement in most of the IWQOL-Lite domains, excluding “sexual life” and “work,” which thus indicates a relation between weight loss and quality of life reflected by better scores in the IWQOL-Lite questionnaire after the follow-up.

Exercise programs combined with dietary therapy improve 6MWT distance and have shown functional changes in patients with obesity [24]. In our study, we were able to observe an increase in the distance traveled and walking speed after the 3-month follow-up from 430 ± 69.7 to 481.2 ± 68; in addition, we found a relationship between the distance covered in the 6MWT and the maximum oxygen consumption. These findings had already been reported previously, where the distance covered during a 6MWT provides an excellent estimate of VO2max during exercise [25].

Different exercise programs have been shown to be superior to control to reduce anthropometric variables in patients with obesity; however, exercise, as an isolated intervention, has a minimal effect on body weight. Given the limited impact on body weight and BMI of exercises programs, it is important to evaluate the effect of exercise on other anthropometric measures, such as waist circumference and % body fat and cardiorespiratory fitness [26]. It is likely that the anthropometric changes found in our group of patients are the result of the combination of multiple interventions (dietary habits, medications, exercise, etc.); however, the changes in physical performance can be attributed to the exercise program; improvement in VO2max have been reported in patients with obesity after a moderate-intensity exercise program [27].

The current guidelines recommend that exercise programs for weight loss in obesity prioritize continuous moderate-intensity aerobic exercise, and that this approach be supplemented, where possible, with resistance training [28, 29]. Most studies have shown that although aerobic exercise training without dietary restriction may induce modest weight loss (∼2–3 kg), in general, it is unlikely to result in clinically significant weight loss (≥5% weight loss) [30]. In our study, we evaluated the effects of a home-based exercise program combining aerobic and resistance exercise. Although other studies reported no improvement in body weight loss with exercise, we found an improvement in some anthropometric variables, such as a body weight reduction of around 10%, a 9.4% change in BMI, and a reduction in hip circumference and waist circumference after 3 months of follow-up. Furthermore, in our study, the participants showed an improvement in body composition with a loss of fat mass and lean mass.

Finally, some studies have shown a positive effect of exercise on biochemical parameters, mainly those related to lipids (reduction of triglycerides and increase of HDL) and no changes in glucose or glycated hemoglobin parameters, at least in obese children [31]. In this study, the only biochemical change observed was in the percentage of glycosylated hemoglobin; however, we need to explore other biochemical variables (HOMA, insulin levels, hepatic, and renal markers) that could reflect the effect of exercise on biochemical parameters.

The effect of exercise on physical performance, biochemical markers, and quality of life in patients with obesity is known and has been previously reported. In this study, results like those of previous studies were obtained; however, the contribution of this work focuses on the design of a structured and easy-to-implement home exercise program that promotes improvement in the quality of life and physical performance of people with obesity. Long-term follow-up and sample expansion are needed to corroborate these findings.

Patients who met the inclusion criteria were invited and those who accepted signed informed consent. This study protocol was reviewed and approved by the Ethics and Research Committees at the Hospital General de México “Dr. Eduardo Liceaga,” that belongs to national health services in Mexico, approval number DI/17/402/3/009 and was conducted ethically in accordance with the Declaration of Helsinki.

The authors have no conflicts of interest to declare.

The present work was financed with the researchers’ own budget; no external funding was obtained. The open access publication process has been covered by the Universidad Iberoamericana in Mexico City.

LLCO: participated in the conception and design of the study as well as the generation, assessments, follow-up, collection, assembly, analysis, and interpretation of the data, drafting and approval of the manuscript final version. MCML and BTI: participated in the drafting of manuscript. ASCA and TCMN: participated in the assessment and follow-up of patients. RSA: participated in the exercise implementation.

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