Implementing exercise programs in individuals who are overweight or living with obesity is often considered, alongside a programme of dietary change, to be beneficial for supporting weight management and general health but the impact on quality of life is often not measured, or at most included as a secondary outcome. A large systematic review, including 56 trials, investigated the impact of lifestyle and physical activity interventions on quality of life in obese individuals (1). However, only 2 of the included trials formally measured quality of life outcomes. One of these studies implemented a two-year weight loss program and post-intervention the study reported a 12.8% increase in physical function, a 7.2% increase in body pain and 11.6% increase in general health scores on the SF-36. The second study specifically included obese individuals with sleep-disturbance symptoms and improvements in sleep, mobility, mood and multiple other quality of life indicators were reported after just one month of a rehabilitation program.
A systematic review and meta-analysis performed by Carraca et al., found that exercise induced positive changes in quality of life but did not reduce depression in overweight or obese individuals (2). The 31 included studies implemented aerobic, resistance or combined regimes lasting a median of 60 minutes, three times weekly for 12 weeks. Subgroup analysis showed that combined aerobic and resistance exercise programs were more effective in improving physical subcomponents of the SF-36 (Physical functioning: 0.77, 95% CI 0.53–1.00; Role-physical: 0.73, 95% CI 0.41–1.05; Bodily pain: 0.51, 95% CI 0.28–0.74; General health: 0.44, 95% CI 0.14–0.73), while aerobic-only and resistance only exercise programs showed non-significant effects.
The positive effect of exercise is further supported by work comparing quality of life changes following dietary or exercise interventions in older adults with obesity (3). Interventions with exercise components (aerobic and resistance) lead to greater improvements in physical performance measures and quality of life compared to diet-only interventions in the six included RCTs, but the quality of methodology was considered low to moderate.
Barrow et al., investigated the principles of exercise programs associated with improved quality-of-life measures, specifically pain and physical function, in obese adults (4). A total of 7 RCTs were included, these were all of low quality (graded poor or fair). Exercise programs lasted approximately 30-60 minutes three times weekly at 40-80% VO2max. Only one study investigated the effects of the exercise program on pain using a sub-domain of SF-36. Pain scores improved by 1.3 points in the high intensity exercise arm, but this was not significant compared to controls. Six studies reported improvements in physical function associated with aerobic exercise with a further study including both aerobic and resistance training also finding a statistically significant improvement in SF-36 physical function scores compared to baseline.
Quality of Evidence:
Grade B – RCTs have some inconsistencies in QOL domains affected with some concerns about methodology reported
Strength of Recommendation:
1 – Significant benefit in certain QOL domains without adverse effects
Exercise interventions likely improve physical function and this is probably increased if aerobic and resistance training is combined. There is mixed evidence for the impact on pain and mental health components of quality-of-life scores and more research is required before strong recommendations can be made for these factors.
- Baillot A, Romain AJ, Boisvert-Vigneault K, Audet M, Baillargeon JP, Dionne IJ, Valiquette L, Chakra CN, Avignon A, Langlois MF. Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis. PLoS One. 2015 Apr 1;10(4):e0119017. doi: 10.1371/journal.pone.0119017. PMID: 25830342; PMCID: PMC4382170.
- Carraça EV, Encantado J, Battista F, Beaulieu K, Blundell JE, Busetto L, van Baak M, Dicker D, Ermolao A, Farpour-Lambert N, Pramono A, Woodward E, Bellicha A, Oppert JM. Effect of exercise training on psychological outcomes in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev. 2021 Jul;22 Suppl 4(Suppl 4):e13261. doi: 10.1111/obr.13261. Epub 2021 May 6. PMID: 33960106; PMCID: PMC8365728.
- Batsis, J. A., Gill, L. E., Masutani, R. K., Adachi-Mejia, A. M., Blunt, H. B., Bagley, P. J., Lopez-Jimenez, F., & Bartels, S. J. (2017). Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. Journal of the American Geriatrics Society, 65(2), 257–268.
- Barrow DR, Abbate LM, Paquette MR, Driban JB, Vincent HK, Newman C, Messier SP, Ambrose KR, Shultz SP. Exercise prescription for weight management in obese adults at risk for osteoarthritis: synthesis from a systematic review. BMC Musculoskelet Disord. 2019 Dec 20;20(1):610. doi: 10.1186/s12891-019-3004-3. PMID: 31861990; PMCID: PMC6925458.