We all know that regular exercise is just as important as daily healthy food choices for weight loss, and a new report in Medicine and Science in Sports and Exercise (R). 2010;42(1):152-159 demonstrates that including aerobic exercise also helps decrease insulin resistance. Reducing calories AND increasing exercise promote weight loss, but this combination also improves insulin sensitivity and decreases LDL cholesterol. How comfortable are you talking about exercise with your clients? The American College of Sports Medicine's "Exercise is Medicine" campaign encourages all health professionals to talk about daily physical activity with our clients. You'll find useful information and tools on this prorgram at http://www.exerciseismedicine.org/fitpros.htm. I would love to hear how others are using this information in your practice, and what types of results you're seeing with your clients.

Lynne: this is a great resource.  During the assessment process I will determine my client's interest in being more physically active, if they aren't already doing something.  I hear things like:  " when you exercise you have more hunger, so I don't need to be more hungry...Have you heard this from your clients as well?

We were talking about the myth that exercise increases appetite yesterday in one of my classes. I believe that there's research that moderate exercise decreases hunger, and intense exercise increases hunger. I'll have to go back to my files and see what I can find to back this up.

I also find that people often don't eat before they exercise, so of course they'll feel hungry afterward. Often people want to reward themselves with food after exercise, which can lead to eating more calories than they just expended!

I like to recommend that people eat 1-2  hours before exercise, and then schedule a meal or snack following exercise. That way they're not eating more food than usual, just making sure they have the timing correct.

I have read research that demonstrates in women (not men) that vigorous (intense) exercise does lead to increased appetite.  Men, exercise actually suppressed appetite. This increase in appetite in women was not seen when only moderate exercise was conducted.  Women that are heavy exercisers can loose the caloric benefit of exercise by overeating afterwards.  I have also seen in my personal practice where they nap or relax to again lose any caloric gain of the exercise bybeing less active later in the day.  Higher intensity exercise burns more calories but less of those calories come from fat burn.  Moderate intensity exercises burns more body fat.

My best advice to get the most gain from exercise is to have someone eat within 30 minutes of exercising.  The fuel should be a mixture of protein and carbohydrates. With out this fuel at the specific time, you create a negative energy balace which could result in up to 25% of energy coming from protein stores (muscle tissue).   Having fuel with this time range is when you have the most likelyhood of muscle development to be able to gain from your hard work.

Lynne,

What a great post about exercise. I actually use a quote when talking to my groups about exercise. The quote was from a physician at the National Institutes of Health. I am sorry I do not remember his name. But I do remember his quote:

     "If exercise could be packed into a pill, it would be the most widely prescribed, and the most beneficial medicine in
      the nation".

I suggest adding exercise to your appointment calendar and keeping the appointment like you would any other appointment. And look at it like a prescription for good health. The more I learn about the health benefits of exercise, the more I wonder if exercise is not the most important key to a healthy life. What do you think?

Roxy

I did some searching for research on exercise and appetite:

http://www.sciencedaily.com/releases/2008/12/081211081446.htm

found that aerobic exercises suppresses appetite by decreasing grehlin and increasing peptide YY levels

http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27706v1

this study on 58 overweight or obese adults showed both an increase in overall hunger and fasting hunger when participating in a 12-week exercise program AND increased satiety of breakfast.

http://www.medscape.com/viewarticle/715082_6

This study speaks to the differences between men and women with appetite and exercise that Joni talked about.

Interesting stuff! I like to ask my clients to use a hunger scale to rank their hunger throughout the day, and to work to differentiate between physical hunger and simply wanting to eat. This usually helps them pinpoint what's going on, and where they can make meaningful changes.

Thanks, Lynn...all good references. This is a wonderful topic. 

I always present exercise as one of the therapies to achieve glycemic control. I usually present achieving glycemic control  as putting together the pieces of a puzzle:
In a graphic illustration of 4 puzzle pieces, I encourage patients to think of how they can solve this puzzle for themselves.  Which therapeutic area will they choose to concentrate on. I list food, exercise, medication and stress management in one of the four puzzle pieces. I then say if you increase effort in exercise, diet or stress management it can be just as therapeutic as medication and probably will result in requiring a lower dose of medication of in some cases elimination of a diabetes medication. Following this message with recommending a pedometer to track progress is usually very effective with patients ready to embark on self management strategies.

I would be interested in finding out what strategies other people use to entice patients into readiness to start using exercise as a therapy for glycemic control

I love the idea of four puzzle pieces to explain how all of the self-care treatments work together!

I think that often just the word "exercise" is scary to people. They think it means joining a gym, sweating, and being around a lot of thin and fit people wearing spandex. Because of this, I often talk about moving your body, or increasing activity instead of exercise. Using a pedometer is one key strategy for many people because it starts with where they are right now, and encourages them to gradually add more steps to their day.

I also encourage my clients to think about ways to have fun and move at the same time. Dancing, throwing a ball with their child, or asking a friend to walk with them and talk instead of talking over coffee are some ideas that work well with my clients. I also have several people who started using the Wii or WiiFit, and love it! It's a family fun activity, and I also several older couples without children at home who 'play' with the Wii every evening before watching their favorite TV shows. They have fun and get exercise at the same time.