Weight loss and the maintenance of weight loss are situations that require different caloric deficits. While weight loss in the short term seems to be easy to achieve with a large enough deficit, weight loss tends to plateau at about 6 months, and partial or complete regain of weight is common.

Exercise may play a larger role in the phase after weight loss than in the weight loss phase itself. Wier and colleagues (1) looked at weight changes over 5 years and found that those who maintained higher physical activity levels had less weight regain in both men and women of all ages (25 to 55 years). It should be stated that, while people who maintain their weight seem to engage in exercise, a causal relationship between exercise levels and weight loss maintenance has not yet been established (2).

Exercise Motivation

The failure to achieve a long-term change in physical activity after 18 months of an intervention suggests that the behavioral methods used to increase physical activity (self-monitoring, increasing motivation, relapse training, reinforcement strategies, increases in self-efficacy) are not effective in the long run with many individuals. Both the Jakicic and Jeffery (3, 4) studies demonstrate the benefit of increased physical activity for those who are successful physical activity maintainers.

It is essential that new ways be found in order to help a greater percentage of people maintain long-term physical activity changes to accomplish higher physical activity levels. It takes 1 hour or more of daily physical activity to successfully maintain weight loss for many individuals. Other than the continuous care model where the intervention continues after 18 months, novel approaches that will foster long-term weight loss with 1 hour or more of daily physical activity need to be tested as an essential part of the approach.

Maintaining Long-Term Exercise

Maintaining physical activity levels over the long run is critical for sustaining weight loss at any age and for preventing sarcopenia and osteoporosis in the older adult population.

In their review article, Brawley, Rejeski, and King (5) found few studies on the effect of long-term sustainability of exercise, particularly in older adults. Sansano-Nadal and colleagues (6) reviewed several strategies to enhance long-term maintenance of physical activity and concluded that the lack of high-quality studies and the failure to design interventions with sustainability in mind have yielded unclear effects of the maintenance of activity beyond 1 year.

Lackman and colleagues (2018) presented a personalized and multicomponent approach to increasing physical activity in older adults with a concern for sustainability of behavioral changes. This model will contribute to future studies on developing better approaches to fostering long-term activity levels.

References

1. Wier, L.T., G.W. Ayers, A.S. Jackson, A.C. Rossum, W.S. Poston, and J.P. Foreyt. 2001. “Determining the Amount of Physical Activity Needed for Long-Term Weight Control.” International Journal of Obesity and Related Metabolic Disorders 25 (5): 613-621. https://doi.org/10.1038/sj.ijo.0801586.
2. Foright, R.M., D.M. Presby, V.D. Sherk, D. Kahn, L.A. Checkley, E.D. Giles, A. Bergouignan, et al. 2018. “Is Regular Exercise an Effective Strategy for Weight Loss Maintenance?” Physiology and Behavior 188: 86-93.
3. Jakicic, J.M., B.H. Marcus, W. Lang, and C. Janney. 2008. “Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women.” Archives of Internal Medicine 168 (14): 1550-1559. https://doi.org/10.1001/archinte.168.14.1550.
4. Jeffery, R.W., K.M. Kelly, A.J. Rothman, N.E. Sherwood, and K.N. Boutelle. 2004. “The Weight Loss Experience: A Descriptive Analysis.” Annals of Behavioral Medicine 27 (2): 100-106. www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15026294.
5. Brawley, L.R., W.J. Rejeski, and A.C. King. 2003. “Promoting Physical Activity for Older Adults: The Challenges for Changing Behavior.” American Journal of Preventive Medicine 25 (3 Suppl 2): 172-183. https://doi.org/10.1016/s0749-3797(03)00182-x.
6. Sansano-Nadal, O., M. Gine-Garriga, J.S. Brach, D.M. Wert, J. Jerez-Roig, M. Guerra-Balic, G. Oviedo, et al. 2019. “Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.” International Journal of Environmental Research and Public Health 16 (14). https://doi.org/10.3390/ijerph16142527.

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