A new American Heart Association scientific statement finds that exercise does far more than help shed pounds, improving cardiovascular health, preserving fitness, and strengthening long-term obesity treatment outcomes, even when the scale barely moves.
Study: Role of Physical Activity in Obesity Treatment and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Image credit: Ljupco Smokovski/Shutterstock.com
A recent scientific statement from the American Heart Association's Circulation summarizes the role of physical activity in the treatment of obesity and cardiometabolic health.
Exercise improves health beyond weight loss
Obesity is a major contributor to cardiovascular disease (CVD) risk due to its association with hypertension, dyslipidemia, and insulin resistance. It affects approximately 42% of U.S. adults. Obesity management focuses on weight loss (WL) and CVD risk reduction, with physical activity (PA) as a central component for both. The AHA statement summarizes the role of physical activity (PA) in cardiometabolic health, WL, and weight-loss maintenance (WLM) and highlights behavioral strategies to increase PA in overweight and obese populations.
Multiple studies have shown that PA provides independent cardiometabolic benefits, including reductions in blood pressure, improved insulin sensitivity, and favorable changes in lipid profiles. Both aerobic and resistance exercise modalities are effective, with greater exercise volumes generally producing larger improvements in weight-loss outcomes, while higher exercise intensities may provide additional benefits for cardiorespiratory fitness.
PA alone rarely leads to substantial WL unless performed at high volumes. Most individuals achieve modest WL, and fewer than 15% reach clinically significant reductions through PA alone. Combining PA with caloric restriction produces greater WL and improved cardiometabolic outcomes, although physiological adaptations, such as increased hunger and reduced metabolic rate, may reduce these effects. Adequate protein intake and resistance training help preserve lean mass during WL.
Long-term WLM remains challenging, as weight regain often reverses health gains. High levels of PA (200–300 minutes per week) are associated with improved WLM, but adherence to these volumes is difficult for many. Gradual progression to at least 150 minutes per week of moderate-to-vigorous PA is recommended, with further increases as needed. Maintaining PA supports ongoing cardiometabolic health, even with some weight regain.
Weight-loss treatments work alongside an active lifestyle
Obesity medications and bariatric surgery are key options for individuals with high BMI when lifestyle changes are not enough. Although medications such as GLP-1 receptor agonists (GLP-1RAs) and bariatric surgery are effective, their use is limited by cost, access, and side effects. These interventions should be accompanied by ongoing lifestyle strategies, especially increased physical activity, to improve weight management.
The advent and expansion of GLP-1RA-based obesity medications, such as liraglutide, semaglutide, and tirzepatide, have markedly improved pharmacological WL outcomes, with some trials reporting weight-loss outcomes approaching those observed after bariatric surgery. These medications primarily act by reducing appetite and slowing gastric emptying, though side effects are common but often manageable.
Clinical trials have demonstrated significant reductions in body weight, and some GLP-1RAs have also been associated with improved cardiovascular outcomes in specific patient populations. For example, liraglutide and semaglutide have been shown to reduce major adverse cardiovascular events in selected high-risk populations. However, the statement notes that the independent and synergistic contributions of physical activity to these outcomes remain insufficiently studied. Nevertheless, most studies lack detailed analyses of the independent or synergistic effects of PA alongside medication, leaving questions about optimal exercise regimens for this population.
With respect to lean mass, a considerable fraction of total WL from GLP-1RA therapy is attributable to loss of lean tissue, though the clinical significance of this remains uncertain. Limited studies directly compare medication alone versus medication combined with exercise, but available evidence suggests greater fat and weight loss and improved cardiorespiratory fitness (CRF) when PA is incorporated. However, robust, controlled trials are needed to clarify the specific benefits and optimal characteristics of PA for patients receiving pharmacotherapy for obesity.
PA levels are typically lower in bariatric surgery candidates, and there are no standard preoperative guidelines. While insurance may require pre-surgical PA programs, evidence for their impact on outcomes is limited and mixed. After surgery, greater PA is associated with greater weight loss, fat loss, maintenance, cardiorespiratory fitness, and muscle strength. However, effects on cardiometabolic risk factors remain inconsistent, and access to PA programs after surgery is often limited.
Wearables and coaching may improve exercise adherence
Clinicians are integral in supporting WL and promoting PA by implementing structured, evidence-based interventions such as the 5A model (assess, advise, agree, assist, arrange). The 5A framework enhances obesity management by structuring physician-patient communication, guiding clinical assessment, and ensuring systematic follow-up. Each incremental step within this model increases patient engagement in WL strategies, including dietary modifications and increased PA, thereby facilitating more consistent adoption of health-promoting behaviors.
Effective application requires a thorough assessment of a patient’s current PA levels and relevant psychosocial or comorbid conditions that may impede progress. Clinicians should evaluate readiness and self-efficacy for behavior change and tailor counseling to each individual’s clinical profile. This approach reinforces patient motivation and strengthens the therapeutic alliance, supporting adherence to PA as a treatment component.
Operationalizing the 5A model also involves assisting patients in identifying and addressing barriers to PA, utilizing collaborative problem-solving, and facilitating access to multidisciplinary resources. Given the limitations of brief clinic visits and the need for sustained support, referrals to behavioral counseling or digital health programs may enhance accountability and PA maintenance.
The statement also highlights the growing role of wearables, smartphone applications, text messaging, personalized feedback, and self-monitoring tools in supporting physical activity. At the same time, it notes important considerations regarding digital health equity, accessibility, and the validity and reliability of activity-tracking devices. Iterative assessment and structured follow-up are crucial for long-term success in managing obesity and cardiometabolic health.
Exercise remains a cornerstone of obesity treatment
PA is a vital component of comprehensive obesity treatment, supporting WL, WLM, and overall health. While advances in medications and bariatric surgery are important, incorporating PA as an adjunctive therapy offers additional benefits for cardiovascular risk, body composition, CRF, and quality of life. Importantly, many of these cardiometabolic and fitness benefits occur independently of weight loss, underscoring the value of physical activity even when reductions in body weight are modest.
Multidisciplinary collaboration among clinicians and auxiliary health care professionals is crucial for fostering and sustaining WL. Programs should be designed to be effective, accessible, and affordable, especially for underresourced populations with higher rates of obesity and lower PA levels. Emphasizing the broad advantages of PA can enhance the long-term success of obesity treatments and help reduce the burden of obesity-related cardiovascular disease.
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