greicewes@gmail.com

sbaruki@yahoo.com.br

tamires.mori@live.com

milmonte@gmail.com

eli.forti@outlook.com

*Master in the Graduate Program in Human Movement Sciences, 

Methodist University of Piracicaba (UNIMEP), Piracicaba, SP. PhD in the 

Associate Graduate Program in Physical Education. Member of Nucleus of Multiprofessional 

Studies of Obesity, University Hospital of Maringa. State University of Maringa – Maringá, PR

**PhD in the Graduate Program in Human Movement Sciences, Methodist University of Piracicaba, Piracicaba, SP. 

Assistant Professor of the Degree course in Physical Education, Federal University 

of Mato Grosso do Sul, Campus Pantanal, Corumbá, MS

***Master and PhD in the Graduate Program in Human Movement Sciences

Methodist University of Piracicaba (UNIMEP), Piracicaba, SP

****PhD, Professor the Graduate Program in Human Movement Sciences

Methodist University of Piracicaba, Piracicaba, SP

(Brazil)

Reception: 03/26/2020 - Acceptance: 08/18/2020

1st Review: 07/28/2020 - 2nd Review: 08/11/2020

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Westphal, G., Baruki, S.B.S., Mori, T.A. de, Montebello, M.I. de L., & Pazzianotto-Forti, E.M. (2020). Effects of Individualized Functional Training on the Physical Fitness of Women with Obesity. Lecturas: Educación Física y Deportes, 25(268), 61-75. Retrieved from: https://doi.org/10.46642/efd.v25i268.2084

 

Abstract

    Introduction: Obesity is a global public health problem with negative impact on health. Therefore, effective treatments options are needed. Objective: to evaluate the responses of a supervised functional training program on physical fitness and functional capacity of women with obesity. Methods: a prospective and controlled study was conducted with twenty-four women, BMI >30 and <55 kg/m² and age between 20 and 59 years. The evaluation consisted of anthropometric measurements and physical fitness tests that assessed the cardiorespiratory fitness and functional capacity [6-minute step test (ST6min)], the indirect strength of the lower limbs [sit-to-stand test (STS)] and the flexibility [sit and reach test (SR)]. After the baseline evaluations, the volunteers were allocated in two groups: individualized training group (ITG) (n=13), which consisted of aerobic and strength training, for three months, three times a week, 60 minutes per session; and the control group (CG) (n=11) which did not participate in any regular physical exercise program during the same period. At the third month the two groups were reassessed. Results: it was observed significative reductions in waist circumference, hip and neck measurements; all with p<0.01; and increase in VO2max, in the number of movements of STS and in distance reached in the SR test, all with p<0.01 for the ITG. The ITG showed superiority over CG for all exercise test variables studied. Conclusion: The training program improved the distribution of body fat, cardiorespiratory fitness, muscular strength, flexibility and functional capacity. These are indicatives that the strategy is feasible for women with obesity.

    Keywords: Obesity. Exercise test. Physical fitness.

 

Resumo

    Introdução: A obesidade é um problema de saúde pública global com impacto negativo na saúde. Portanto, são necessárias opções de tratamentos eficazes. Objetivo: avaliar as respostas de um programa de treinamento funcional supervisionado sobre a aptidão física e capacidade funcional de mulheres com obesidade. Métodos: estudo prospectivo e controlado realizado com vinte e quatro mulheres, IMC> 30 e <55 kg/m² e idade entre 20 e 59 anos. A avaliação consistiu em medidas antropométricas e testes de aptidão física que avaliaram a aptidão cardiorrespiratória e a capacidade funcional [teste do degrau de 6 minutos, a força indireta de membros inferiores e a flexibilidade. Após as avaliações iniciais, os voluntários foram alocados em dois grupos: grupo de treinamento individualizado (GTI) (n=13), que consistia em treinamento aeróbio e de força, por três meses, três vezes por semana, 60 minutos por sessão; e o grupo controle (GC) (n=11) que não participou de nenhum programa regular de exercícios físicos no mesmo período. No terceiro mês, os dois grupos foram reavaliados. Resultados: foram observadas reduções significativas nas medidas de circunferência da cintura, quadril e pescoço; e aumento do VO2máx, do número de movimentos do TD6mim. e da distância alcançada no teste de flexibilidade. O GTI mostrou superioridade sobre o GC para todas as variáveis do teste de aptidão física estudadas. Conclusão: O programa de treinamento melhorou a distribuição da gordura corporal, aptidão cardiorrespiratória, força muscular, flexibilidade e capacidade funcional. Esses são indicativos de que a estratégia é viável para mulheres com obesidade.

    Unitermos: Obesidade. Testes físicos. Aptidão física.

 

Resumen

    Introducción: la obesidad es un problema de salud pública global con impacto negativo en la salud. Por lo tanto, se necesitan opciones de tratamiento eficaces. Objetivo: evaluar las respuestas de un programa de entrenamiento funcional supervisado sobre la aptitud física y la capacidad funcional de mujeres con obesidad. Métodos: estudio prospectivo y controlado realizado con veinticuatro mujeres, IMC> 30 y <55 kg/m², edad entre 20 y 59 años. La evaluación consistió en mediciones antropométricas y pruebas de aptitud física que evaluaron la aptitud cardiorrespiratoria y la capacidad funcional, la fuerza indirecta de los miembros inferiores y la flexibilidad. Después de las evaluaciones iniciales, los voluntarios fueron distribuidos en dos grupos: grupo de entrenamiento individualizado (GEI) (n=13), que consistió en entrenamiento aeróbico y de fuerza, durante tres meses, tres veces por semana, 60 minutos por sesión; y el grupo control (GC) (n=11) que no participó en ningún programa regular de ejercicio físico en el mismo período. En el tercer mes, ambos grupos fueron reevaluados. Resultados: se observaron reducciones significativas en las medidas de circunferencia de cintura, cadera y cuello; y aumento del VO2máx, en el número de movimientos del PP6min. y la distancia alcanzada en la prueba de flexibilidad para el GEI. El GEI mostró mejoría sobre el GC en todas las variables estudiadas. Conclusión: El programa de entrenamiento mejoró la distribución de la grasa corporal, la aptitud cardiorrespiratoria, la fuerza muscular, la flexibilidad y la capacidad funcional. Estos son indicativos de que la estrategia es viable para mujeres con obesidad.

    Palabras clave: Obesidad. Pruebas físicas. Aptitud física.

 

Lecturas: Educación Física y Deportes, Vol. 25, Núm. 268, Sep. (2020)

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Introduction 

 

    Overweight and obesity are defined as abnormal or excessive fat accumulation which represents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person's weight (in kilograms) divided by the square of his or her height (in meters). Thus, obesity is an important risk factor for each of the three main non communicable diseases (NCD) responsible for the majority of premature deaths, namely cardiovascular diseases, diabetes and cancer. In addition to the high costs associated with the treatment of obesity comorbidities, failure to meet the goals of containing the disease at the levels presented in 2010 will inevitably bring greater social and economic impacts. With the increase in obesity levels, there will certainly be an increase in the need for social assistance, a higher risk of unemployment and lower national productivity. (World Obesity Federation, 2020)

 

    In current trends, it is expected that 1 in 5 adults worldwide will be affected by obesity by 2025. One third of them will live with severe obesity (BMI over 35 kg/m²) and at high risk of other NCD requiring medical intervention. (World Health Organization, 2015)

 

    Obesity is a global public health problem not only due to the increasing prevalence but also because of the costs of its treatment, since it is a risk factor for metabolic, cardiovascular and osteoarticular problems, which negatively affect the quality of life (Ghroubi et al., 2016) e and the functional capacity (Pataky, Armand, Müller-Pinget, Golay, & Allet, 2014). The practice of appropriated regular physical exercises, which should be based on the individual initial condition, favors the control and treatment of these diseases, the control of morbidity and reduction on the mortality rates, the improvement of the physical fitness and the promotion of quality of life and health. (Pasanen, Tolvanen, Heinonen, & Kujala, 2017)

 

    The improvement of the components of physical fitness related to health as aerobic capacity, muscular strength and endurance, flexibility and body composition is achieved by the increase of physical activity, in a planned, structured and repetitive routine, in other words practicing exercises regularly (Caspersen, Powell, & Christenson, 1985) favoring motor learning, strength gain and physical conditioning, and the functional capacity (Cooke, Mares, Clark, Tallis, & Pomeroy, 2010). The gain of muscular strength contributes to the optimization of physical activities daily, functional or recreational and, consequently, for better quality of life. (Ratamess, & Alvar, 2009)

 

    However, for the maintenance of health and physical fitness for adults, it is recommended at least 150 minutes per week of aerobic physical exercises, with moderate intensity, for better performance of the cardiovascular system; and two to three bouts a week of muscle strength exercises and flexibility for the preservation of the osteomyoarticular system, the level of physical conditioning and the general health status. (Garber et al., 2011)

 

    Additionally, individuals with obesity have difficulties following these recommendations, perhaps due to physical and psychological barriers such as low exercise tolerance, fear of osteomyoarticular issues, unfavorable social influence and lack of ability and resources(Sarsan, Ardic, Ozgen, Topuz, & Sermez, 2006). Thus this population is more exposed to comorbidities such as cardiovascular and respiratory diseases, metabolic syndrome, type 2 diabetes and dyslipidemia. (Dália dos Santos & Goretti Pessoa de Araújo Burgos, 2015)

 

    Functional training consists of resistance exercises that use the support of the individual's body mass, and implements which are easy to handle and transport making possible a variety of exercises which can be taught and done at different locations. These qualities add to the improvement in stability and motor coordination due to the request for multiarticular and multiplans movements (Corazza et al., 2016), characterized as a good alternative of physical exercises for the population with obesity.

 

    Thus, the benefits of functional training and the importance of maintaining or improving physical fitness and functional capacity to reduce health-related risks (Garber et al., 2011), aggregated to the lack of research aimed at this population, justified the development of the study, adopting as a hypothesis that an individualized and supervised physical training, composed by aerobic and functional exercises provides a globalized, simple and viable body workout for this population. The objective of the research was to evaluate the effect of 12-week functional training on the physical fitness and functional capacity of women with obesity.

 

Methodology 

 

Sample 

 

    A prospective and controlled study was carried out, and the sample selection consisted of the following inclusion criteria: female gender; age between 25 and 59 years old; BMI > 30 and < 55 kg/m²; being able to perform the physical exercises. Women with diagnosed hypertension, diabetes, decompensated cardiopathies, chronic obstructive pulmonary disease, asthma, musculoskeletal and/or neuromuscular issues, pregnancy or puerperium were excluded; and those who participated in physical training in the last six months or were in diet programs for weight loss. It was adopted as discontinuity criteria to initiate a diet or physical training program during the study; or the lack of adaptation to it. All volunteers were informed about the research and signed an informed consent form. The study complied with the norms of resolution 466/12 of the National Health Council (NHC) and was approved by the Ethics and Research Committee of the Methodist University of Piracicaba (UNIMEP), under the register nr. 19/2014.

 

Procedures 

 

    The evaluations were carried out in the Evaluation And Intervention Laboratory Applied to the Cardiorespiratory System (LAIASC) of the same university, in two days, with an interval of 48 hours to 72 hours. On the first day the anthropometric characteristics and physical fitness were evaluated by means of physical tests. On the second day, only the physical tests were performed, respecting the rest between them and the normalization of vital signs and their execution order was determined randomly, by means of a draw using sealed opaque envelopes.

 

    For the diagnosis of BMI, the values of body mass (BM) (kg) and height (m) were used. Waist circumference (WC) (cm) was determined at the midpoint between the lower margin of the last palpable rib and the superior anteroposterior iliac crest; and hip circumference (HC) (cm), at the level of the greater trochanter of the femur or of the greater gluteal bulge, standing, feet apart, arms along the body, and evenly distributed weight (World Health Organisation [WHO], 2011). The neck circumference (NC) (cm) was measured in the upright position, the head in the Frankfurt plane and the measuring tape below the prominence of the larynge. (Fitch, Stanley, Looby, Rope, & Grinspoon, 2011)

 

    To evaluate cardiorespiratory physical fitness and functional capacity, the 6-minute Step Test (ST6min) was applied on a 20 cm height step (Tryexx Fitness, São Paulo, Brazil), in which the volunteers were instructed to climb the highest number of times, during 6 minutes (Pessoa et al., 2012), and the outcome was the number of climbles on the Step (NST). The recommendations of the ATS (Crapo et al., 2002) for the walking test 6 minutes were followed in the monitoring and interruption of the test. Cardiorespiratory fitness was assessed by indirect calculation of VO2max, by means of ST6min, by the ACSM (Haskell et al., 2007) formula for females: VO2ml.kg^-1. Min^-1 = 0.2 x (ascent rate) + 1.33 x 1.8 x (step height in meters) x (ascent rate) + 3.5. The ascent rate was determined by the NST divided by the time spent in the test (6 minutes). The values achieved in the number and pace of climb ups on the step expressed the functional capacity. (Carvalho et al., 2015)

 

    For the evaluation of the indirect strength of the lower limbs, the sit and lift test (SL) was conducted in a chair with 40 cm height, with backrest, in the seated position, standing column and crossed arms against the thorax. The volunteers were encouraged to sit and stand up, the largest number of times, in 30 seconds without the aid of the arms. (Stegen, Derave, Calders, Van Laethem, & Pattyn, 2011)

 

    The flexibility of the trunk and hamstring muscles was measured by the sit and reach test (SR), on the Wells bench, on a stretcher with extended knees and feet supported on the front surface of the bench. From this position they bend the upper body to the maximum point of their reach with their hands on a stepped ruler (cm), from the point zero. (Cardoso, Azevedo, Cassano, Kawano, & Âmbar, 2007)

 

    After the evaluations, consecutively, two groups matched by age and BMI were formed: Individualized Training Group (ITG), with 13 volunteers and the control group (CG), with 13 participants who agreed to participate in the study, met the criteria of inclusion and completed the initial assessments. The two groups were reevaluated after three months. Two CG volunteers did not attend final assessments.

 

    The physical training took place in the laboratory of the university, at the Family Health Center, in the district, or at the volunteer's residence.

 

Intervention protocol (ITG) 

 

    The physical training program comprised 36 sessions of approximately 60 minutes of aerobic and resisted exercises, three times a week, for 12 weeks. Aerobic training was set to light to moderate intensity (40 to 59% of the Reserve Heart Rate - RHR); and Training Heart Rate (THR), determined by the formula of Karvonen (Karvonen MJ, 1957): THR= Rest Heart Rate + (RHR x% intensity)/100; where the RHR = Maximal Heart Rate – Rest Heart Rate; and maximum HR = 220 ­ age. Respecting the principle of physical training overload, in the first month, the training was 30 minutes of walking, with TRH from 40 to 45% of the RHR; In the second month, 35 minutes, between 45 and 55%; And in the third month, 40 minutes, from 55 to 59%, from the RHR.

 

    After the aerobic training (walk), resistance exercises were performed, with functional characteristics, with a mat, chair and rubber bands, for the lower limbs and the upper body muscle (trunk), according to the progression in the training volume: 3 sets of 12 repetitions in the first month; 4 series of 12 repetitions in the second month; and 4 sets of 15 repetitions in the third month. The exercises were: abduction and adduction of lower limbs in dorsal decubitus; Extension and flexion of the knees, standing and in dorsal decubitus; Sit and stand up from the chair; and plantar flexion in standing, for the lower limbs; Flexion of arms and alternating biceps thread, frontal elevation, frontal and dorsal crucifix, with the aid of a rubber bands (TheraBand blue), for the upper limbs; and abdominals in dorsal decubitus, with knees flexed, to the dorsal region and trunk.

 

    The monitoring of the load and intensity of the training was performed by the subjective perception of exertion, through the Borg scale, values from 11 to 14, considering a slight intensity to moderate (Noronha et al. 2015). The session ended with stretching for the muscular groupings worked. These procedures are aligned with the recommendations of the American College of Sports Medicine. (Donnelly et al., 2009)

 

Statistical analysis 

 

    The sample size was based on a pilot study with the first six volunteers from each group, considering for the calculation, the averages of the differences between the values obtained before and after 12 weeks of intervention. The outcome variable was the maximal oxygen uptake (VO2max), calculated indirectly by the number of climbles in the step test, with power of 80% and α 5%. Twelve volunteers were determined in each group, considering probable sample loss, 13 volunteers were included in each group, totaling 26 volunteers in the study.

 

    To evaluate the normality of data distribution, the Shapiro-Wilk test was applied. To compare the variables, between the first and the second evaluation (intra analysis), we used the paired Student's T-Test (parametric data) or the Wilcoxon test (non-parametric data); And, in the intergroup analysis, the unpaired Student test, for independent samples (parametric data) or the Mann-Wittney test (non-parametric data). The SPSS software (Field, 2009), version 21.0, was used for the analyses, and the significance level of 5% (P < 0.05) was adopted. The analysis of the effect size of the physical exercise program was determined by the Cohen coefficient, by the application "Effect Size Generator", version 2.3 (Swinburne University of Technology, Center for Neuropsychology, Melbourne, Australia), for the In the ITG compared to the CG, using the means of differences between assessments and revaluations. It was considered value ≥ 0.8, large effect; Between 0.2 and 0.8, moderate effect; and < 0.2, Small Effect. (Cohen, 1988)

 

Results 

 

    The final sample consisted of 24 women with obesity, from 20 to 59 years old, divided into two groups: ITG, with 13 volunteers; and CG, with 11 volunteers, according to flowchart (Figure 1).

 

 

    Table 1 presents the initial data of the groups related to anthropometric characteristics and functional tests, without significant differences between the groups evaluated before the intervention.

 

Variables	ITG (n=13)	CG (n=11)	p-between
Age (years)	45,69 ± 10,38	39,45 ± 9,86	0,14
Overweight (Kg)	89,40 ± 15,79	100,43 ± 12,31	0,07
Height (m)	1,59 ± 0,07	1,64 ± 0,07	0,09
BMI (Kg/m2)	35,48 ± 5,20	37,45 ± 2,94	0,27
NC (number of climb n)	153,38 ± 16,27	134,45 ± 37,31	0,28
VO2máx (ml/kg-min-1)	20,85 ± 1,84	18,71 ± 4,22	0,28
STS (repetitions)	15,54 ± 1,80	14,18 ± 3,60	0,25
SA (cm)	11,95 ± 5,72	16,18 ± 9,12	0,17

ITG: Individualized Training Group; CG: Control Group; BMI: Body Mass Index; 

NC: number of climbles in the step test; VO2 Max: the maximal oxygen uptake (VO2max); 

SL: the sit and lift test (SL); SR: sit and reach test.

 

    In the intra-group comparison, there was a reduction only in the ITG for WC (p<0.0001), HC (p< 0.0001), WHR (p = 0.01) and NC (p = 0.01). In the intergroup analysis, a reduction was observed only in HC(p< 0.01), in the ITG (table 2).

 

Variables		ITG Base-line (n=13)	p intra	ITG post (n=13)	dif	CG Base-line   (n=11)	p intra	CG post (n=11)	dif	p Between
Body mass  (kg)	M DP	89,40 15,79	0,08	89,98 16,63	-0,58 1,53	100,43 12,31	0,5	102,81 15,40	-2,38 7,19	0,77
Overweight (kg)	M DP	35,10 2,47	0,09	35,67 15,51	-0,58 1,53	42,81 9,45	0,14	45,19 13,14	-2,38 7,19	0,77
BMI (kg/m²)	M DP	35,48 5,20	0,11	35,58 5,38	-0,20 0,56	37,45 2,94	0,14	38,33 4,40	-0,88 2,62	0,79
WC  (cm)	M DP	101,62 9,84	<0,0001*	95,09 10,11	6,54 3,84	108 12,31	0,5	108 15,22	0 9,47	0,05
HC (cm)	M DP	119 13,10	<0,0001*	115,08 12,93	3,92 2,14	128,60 8,90	0,27	129,91 12,28	-1,31 7,08	0,01*
WHR  (cm)	M DP	0,86 0,07	0,01*	0,83 0,06	0,03 0,03	0,84 0,09	0,18	0,83 0,08	0,01 0,04	0,19
NC (cm)	M DP	37,84 2,47	0,01*	36,54 2,60	0,54 0,52	36,64 1,39	0,12	36,20 0,82	0,44 1,42	0,70

ITG: individualized training group; CG: control group; BL: Base Line; post: post intervention; dif: difference between BL and Post; M: mean; SD: standard deviation; Body Mass (BM); Overweight (OW); BMI: body mass index; WC: waist circumference; HC: Hip circumference; WHR:: waist-hip ratio; NC: neck circumference; *: significant (p<0,05).

 

    Table 3 expresses the results of physical fitness and functional capacity, evidencing significative increase in VO2max (p< 0.0001), in the NSD (p< 0.0001), in the number of SL movements (p< 0.0001), in the distance achieved in the SA test (p< 0.0001), for the ITG in Regarding the CG, in the intra-group analyses. In the intergroup analyses, the ITG showed superiority in relation to the CG for all variables studied (p < 0.001).

 

Variables		ITG BL (n=13)	P intra	ITG post (n=13)	dif	GC BL (n=11)	P intra	GC post (n=11)	dif	p Between
SL (n)	M D	15,54 1,94	<0,0001*	20,46 3,07	+4,92 1,89	14,18 3,60	0,08	13,36 4,13	-0,82 1,89	<0,0001*
SR (cm)	M D	11,95 5,72	<0,0001*	15,43 5,32	+3,48 1,62	16,98 9,12	0,11	15,22 8,99	-0,96 2,49	<0,0001*
VO2 MÁX (ml/kg-1/min-1)	M D	20,85 1,84	<0,0001*	23,33 2,03	+2,48 0,79	18,71 4,22	0,09	18,17 4,07	-0,55 1,37	<0,0001*
NC (n)	M D	153,30 16,27	<0,0001*	175,31 17,91	+26,15 36,03	134,45 37,31	0,10	129,64 35,97	-4,82 12,09	<0,001*

ITG: individualized training group; CG: control group; BL: Base Line; post: post intervention; dif: difference between BL and Post; M: mean; SD: standard deviation; NC: number of climbles in the step test; VO2 MÁX: the maximal oxygen uptake (VO2max); SL: sit and lift test (SL); SR: sit and reach test.

 

    Table 4 describes the size of the effect of the physical exercise program. There was a great effect for WC and mean effect for BW, BMI, HC, WHR, in the ITG group. Regarding the TD6, in the ITG, there was a great effect on the cardiorespiratory fitness VO2max and mean effect on the NSD. The SL and SA tests showed great effect and mean effect, respectively, in the GTI.

 

Variables	Cohen’s d
Body Mass (kg)	0,34**
BMI (kg/m2)	0,35**
WC (cm)	0,90*
HC (cm)	0,49**
WHR (cm)	0,56**
NC (cm)	0,094
VO2 (ml/kg-1/min-1)	1,72*
NC (number of climbles n)	0,79*
SL (n)	2,16**
SR (cm)	0,60*

ITG: individualized training group; CG: control group, BMI: body mass index; 

WC: waist circumference; HC: hip circumference; WHR: hip waist ratio; 

NC: neck circumference; VO2 maximal oxygen uptake per kilogram body weight per minute; 

NSD: number of climbles on TD6 SL: sit and stand test; 

SA: sit and reach test; *: big effects; **: average effects.

 

Discussion 

 

    The results evidenced improvements in physical fitness (oxygen consumption, lower limb strength and trunk flexibility), and functional capacity (number of climbles on the Step), and further reduction of circumferences measures, maintenance of the Body Mass and BMI.

 

    Reduction in WC, HC and NC measurements and the maintenance of BM and BMI suggest better distribution of body fat, since body mass was maintained (Beavers et al., 2014). Similar results were observed in other studies which emphasize the physical training not only for body weight loss but in the control of adiposity through the reduction of anthropometric measures such as WC, HC and NC (Benito et al., 2015). However, research with obese individuals found a reduction in body fat, not only with physical exercises, highlighting the role of multidisciplinary actions in the treatment of obesity and that physical activity alone may not be sufficient to promote a body weight reduction (Kirk, Penney, McHugh, & Sharma, 2012). Perhaps, the maintenance of BW in the ITG is justified by the lack of nutritional intervention, which is relevant to improve these results. On the other hand, the maintenance of body mass is an important result considering that weight loss may promote the loss of lean body mass and compromise aerobic capacity. However, physical exercise acts in reducing the loss of lean body mass that will benefit the functional capacity, maintaining the rest metabolic rate and the risk of weight regain. (Weiss, Jordan, Frese, Albert, & Villareal, 2017)

 

    De Liao et al. (Liao et al., 2017) evaluated obese women after 12 weeks of training using the same rubber bands and observed improvements in body composition, evidencing muscle mass gain with significant correlation with physical mobility.

 

    Regarding cardiorespiratory fitness, despite significant differences after the intervention, the VO2max values displayed a group with low cardiorespiratory fitness, according to the ACSM (American College of Sports Medicine, 2014). Considering the aerobic training developed, the improvement in VO2máx reinforce the importance of this training for the obese, optimizing the cardiorespiratory fitness (Dália dos Santos &Goretti Pessoa de Araújo Burgos, 2015). Ozcelik et al. (Ozcelik, Ozkan, Algul, & Colak, 2015) observed an increase in VO2max in obese women, during 12 weeks of intervention with diet and physical exercises, besides the decrease in fat mass and body weight. In the present study, even without the diet, cardiorespiratory fitness improved, evidencing the importance of individualized exercises for the health of obese women, suggesting that the increase in cardiorespiratory fitness may have increased functional capacity.

 

    Individuals with obesity are more vulnerable to functional limitations due to the progressive increase in BMI. The applied physical training brought benefits to the functional capacity in the ITG. Increased strength of lower limbs and flexibility of the trunk and hamstring muscles were observed. (Gomes-Neto et al., 2016)

 

    Gomes-Neto et al. evaluated the functional capacity and quality of life in obese and non-obese elderly, with osteoarthritis, through the 6-minute walk test. They found better results in mobility, rapid gait and physical fitness in the non-obese group. (Gomes-Neto et al., 2016)

 

    Marcon et al. observed an increase in functional capacity in obese patients after aerobic exercises, such as 30-minute walks (Marcon, Gus, & Neumann, 2011). In other words, physical training is essential for people with obesity, not only for body weight loss, but to favor functional capacity and, consequently, the quality of life of this population. Trabka et al. observed changes in functional capacity with increase in oxygen consumption and in the strength of upper and lower limbs, aggregated to alterations in the lipid profile, indicators that contribute to reduce the cardiometabolic risk and improve the quality of life, after a combined training program with aerobic and strength exercises in obese women for 10 weeks. (Trabka et al., 2014)

 

    In addition to lower limb strength, there was an increase in the rhythm of climbles in the ITG. Pataky et al. concluded that individuals with obesity use different strategies to get up and the increase in the ascent time reflects the worsening of the functional capacity of the lower limbs. And the reduction of BMI was the only variable considered to increase the speed of the individual to sit and lift, a result contrary to our study, thus highlighting the gain of muscular strength, since there was no loss of BM. (Pataky et al., 2014)

 

    Regarding the increase in the flexibility of the trunk and the hamstring muscles Farinatti et al. observed significant improvement in trunk flexibility, in 26 men and 52 women, after aerobic exercise, for 2 months, similar to the results of this study. And, in obese patients, functional capacity may be associated with losses in flexibility due to excess body weight. In the present study, the ITG increased flexibility after physical training, a relevant fact that brings benefits to the physical fitness and functional capacity of obese women grades I and II. (Farinatti, Oliveira, Pinto, Monteiro, & Francischetti, 2005)

 

Conclusion 

 

    The proposed functional training complied with the recommendations of the American College of Sports Medicine, with exercises of mild to moderate intensity, for health promotion, improved the distribution of body fat, cardiorespiratory fitness, muscular strength, flexibility and functional capacity. Thus, we can emphasize that the functional training developed can be a good option for physical exercises in the treatment of obesity, being a viable instrument for primary health care services, due to easy applicability and low cost, either in a group or individualized, providing adherence to regular physical exercises and, consequently, clinical benefits regarding cardiometabolic risk factors.

 

    The lack of blindness of researchers regarding the evaluation and intervention processes, the cardiopulmonary exercise test for the indirect evaluation of cardiorespiratory fitness and the lack of a nutritional intervention may be considered limitations of this study. However, it is noteworthy the feasibility of the protocol performed, which can be applied to a large portion of the obese population, usually with low level of physical fitness and low adherence to the physical exercise programs. Thus, the importance of further research in this area is highlighted, for this growing population.

 

Acknowledgment 

 

    CAPES for the master's and doctoral scholarship granted. Special thanks to Mrs. Teresinha Pessoa for the motivation and support in carrying out this study and to PhD. Nelson Nardo Junior for the critical correction of the manuscript.

 

References 

 

American College of Sports Medicine (2014). Diretrizes do ACSM para os Testes de Esforço e sua Prescrição (9ª ed.). Tradução: Dilza Balteiro Pereira de Campos. Rio de Janeiro: Editora Guanabara.

 

Beavers, K. M., Beavers, D. P., Nesbit, B. A., Ambrosius, W. T., Marsh, A. P., Nicklas, B. J., & Rejeski, W. J. (2014). Effect of an 18-month physical activity and weight loss intervention on body composition in overweight and obese older adults. Obesity, 22(2), 325–331. Retrieved from: https://doi.org/10.1002/oby.20607

 

Benito, P. J., Bermejo, L. M., Peinado, A. B., López-Plaza, B., Cupeiro, R., Szendrei, B. et al. (2015). Change in weight and body composition in obese subjects following a hypocaloric diet plus different training programs or physical activity recommendations. Journal of Applied Physiology, 118(8), 1006–1013. Retrieved from: https://doi.org/10.1152/japplphysiol.00928.2014

 

Cardoso, J., Azevedo, N., Cassano, C., Kawano, M., & Âmbar, G. (2007). Confiabilidade intra e interobservador da análise cinemática angular do quadril durante o teste sentar e alcançar para mensurar o comprimento dos isquiotibiais em estudantes universitários. Revista Brasileira de Fisioterapia, 11(2), 133–138. Retrieved from: https://doi.org/10.1590/s1413-35552007000200008

 

Carvalho, L. P., Di Thommazo-Luporini, L., Leheudre, M. A., Bonjorno, J. C., De Oliveira, C. R., Luporini, R. L., Borghi-Silva, A. (2015). Prediction of cardiorespiratory fitness by the six-minute step test and its association with muscle strength and power in sedentary obese and lean young women: A cross-sectional study. PLoS ONE, 10(12), 1–16. Retrieved from: https://doi.org/10.1371/journal.pone.0145960

 

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports (Washington, D.C. : 1974), 100(2), 126–131. Retrieved from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC1424733

 

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Erlbaum Associates, Inc.

 

Cooke, E. V., Mares, K., Clark, A., Tallis, R. C., & Pomeroy, V. M. (2010). The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: A systematic review and meta-analysis. BMC Medicine, 8. Retrieved from: https://doi.org/10.1186/1741-7015-8-60

 

Corazza, S. T., Laux, R. C., Foesch, M. L. S., Dos Santos, D. L., Machado, R. R., Macedo, T. L. et al. (2016). Benefits of functional training for the balance and proprioception in visually impaired persons. Revista Brasileira de Medicina Do Esporte, 22(6), 471–475. Retrieved from: https://doi.org/10.1590/1517-869220162206164644

 

Crapo, R. O., Casaburi, R., Coates, A. L., Enright, P. L., MacIntyre, N. R., McKay, R. T., Mottram, C. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166(1), 111–117. Retrieved from: https://doi.org/10.1164/ajrccm.166.1.at1102

 

Dália dos SANTOS, T., & Goretti Pessoa de Araújo BURGOS, M. (2015). Aspectos Clínicos E Nutricionais Em Mulheres Obesas Durante O Primeiro Ano Após Bypass Gástrico Em Y-De-Roux. ABCD Arq Bras Cir Dig Artigo Original, 28(1), 56–60. Retrieved from: https://doi.org/10.1590/S0102-6720201500S100016

 

Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., & Smith, B. K. (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine and Science in Sports and Exercise, 41(2), 459–471. Retrieved from: https://doi.org/10.1249/MSS.0b013e3181949333

 

Farinatti, P. de T. V., Oliveira, R. B. de, Pinto, V. L. M., Monteiro, W. D., & Francischetti, E. (2005). [Home exercise program: short term effects on physical aptitude and blood pressure in hypertensive individuals]. Arquivos Brasileiros de Cardiologia, 84(6), 473–479. Retrieved from: https://doi.org//S0066-782X2005000600008

 

Field, A.P. (2009). Discovering Statistics using SPSS Statistics. SAGE Publications, 66, 822. Retrieved from: http://www.amazon.com/Discovering-Statistics-using-IBM-SPSS/dp/1446249182

 

Fitch, K. V., Stanley, T. L., Looby, S. E., Rope, A. M., & Grinspoon, S. K. (2011). Relationship between neck circumference and cardiometabolic parameters in HIV-infected and non-HIV-infected adults. Diabetes Care, 34(4), 1026–1031. Retrieved from: https://doi.org/10.2337/dc10-1983

 

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M.,Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359. Retrieved from: https://doi.org/10.1249/MSS.0b013e318213fefb

 

Gomes-Neto, M., Araujo, A. D., Junqueira, I. D. A., Oliveira, D., Brasileiro, A., & Arcanjo, F. L. (2016). Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoarthritis. Revista Brasileira de Reumatologia, 56(2), 126–130. Retrieved from: https://doi.org/10.1016/j.rbre.2015.08.014

 

Ghroubi, S., Kossemtini, W., Mahersi, S., Elleuch, W., Chaabene, M., & Elleuch, M.H. (2016). Contribution of isokinetic muscle strengthening in the rehabilitation of obese subjects. Annals of Physical and Rehabilitation Medicine, 59(2), 87–93. Retrieved from: https://doi.org/10.1016/j.rehab.2016.01.005

 

Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A. et al. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1423–1434. Retrieved from: https://doi.org/10.1249/mss.0b013e3180616b27

 

Karvonen, M.J., Kentala, E., & Mustala, O. (1957). The effects of on heart rate. A “longitudinal” study. Ann Med Exp Biol Fenn, 35(3), 307–315.

 

Kirk, S. F. L., Penney, T. L., McHugh, T. L. F., & Sharma, A. M. (2012). Effective weight management practice: A review of the lifestyle intervention evidence. International Journal of Obesity, 36(2), 178–185. Retrieved from: https://doi.org/10.1038/ijo.2011.80

 

Liao, C. De, Tsauo, J. Y., Lin, L. F., Huang, S. W., Ku, J. W., Chou, L. C., & Liou, T. H. (2017). Effects of elastic resistance exercise on body composition and physical capacity in older women with sarcopenic obesity. Medicine (United States), 96(23). Retrieved from: https://doi.org/10.1097/MD.0000000000007115

 

Marcon, E. R., Gus, I., & Neumann, C. R. (2011). [Impact of a minimum program of supervised exercises in the cardiometabolic risk in patients with morbid obesity]. Arquivos Brasileiros de Endocrinologia e Metabologia, 55(5), 331–338. Retrieved from: https://doi.org/10.1590/S0004-27302011000500006

 

Noronha, F. de R.D., Vale, R.G.S., Nodari Jr., R.J., Giani, T.S., & Bacellar, S., Batista, L.A. et al. (2015). Static balance of elderly women submitted to a physical activity program. Rev. bras. geriatr. gerontol., v.18(4). Retrieved from: https://doi.org/10.1590/1809-9823.2015.14181

 

Ozcelik, O., Ozkan, Y., Algul, S., & Colak, R. (2015). Beneficial effects of training at the anaerobic threshold in addition to pharmacotherapy on weight loss, body composition, and exercise performance in women with obesity. Patient Preference and Adherence, 9, 999–1004. Retrieved from: https://doi.org/10.2147/PPA.S84297

 

Pasanen, T., Tolvanen, S., Heinonen, A., & Kujala, U. M. (2017). Exercise therapy for functional capacity in chronic diseases: An overview of meta-analyses of randomised controlled trials. British Journal of Sports Medicine, 51(20), 1459–1465. Retrieved from: https://doi.org/10.1136/bjsports-2016-097132

 

Pataky, Z., Armand, S., Müller-Pinget, S., Golay, A., & Allet, L. (2014). Effects of obesity on functional capacity. Obesity, 22(1), 56–62. Retrieved from: https://doi.org/10.1002/oby.20514

 

Pessoa, B. V., Jamami, M., Basso, R. P., Regueiro, E. M. G., Di Lorenzo, V. A. P., & Costa, D. (2012). Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC. Fisioterapia Em Movimento, 25(1), 105–115. Retrieved from: https://doi.org/10.1590/s0103-51502012000100011

 

Ratamess NA, Alvar BA, E. T. (2009). Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 41(3), 687–708. Retrieved from: https://doi.org/10.1249/MSS.0b013e3181915670

 

Sarsan, A., Ardic, F., Ozgen, M., Topuz, O., & Sermez, Y. (2006). The effects of aerobic and resistance exercises in obese women. Clinical Rehabilitation, 20(9), 773–782. Retrieved from: http://doi.org/10.1177/0269215506070795

 

Stegen, S., Derave, W., Calders, P., Van Laethem, C., & Pattyn, P. (2011). Physical fitness in morbidly obese patients: Effect of gastric bypass surgery and exercise training. Obesity Surgery, 21(1), 61–70. Retrieved from: https://doi.org/10.1007/s11695-009-0045-y

 

Trabka, B., Zubrzycki, I. Z., Ossowski, Z., Bojke, O., Clarke, A., Wiacek, M., & Latosik, E. (2014). Effect of a MAST exercise program on anthropometric parameters, physical fitness, and serum lipid levels in obese postmenopausal women. Journal of Human Kinetics, 42(1), 149–155. Retrieved from: https://doi.org/10.2478/hukin-2014-0069

 

Weiss, E. P., Jordan, R. C., Frese, E. M., Albert, S. G., & Villareal, D. T. (2017). Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity. Medicine and Science in Sports and Exercise, 49(1), 206–217. Retrieved from: https://doi.org/10.1249/MSS.0000000000001074

 

World Obesity Federation (2020). Obesity: missing the 2025 global targets. n. March, p. 1–242.

 

World Health Organization (2015). Controlling the global obesity epidemic. World Health Organization, v. 7, n. 1, p. 1–2. Retrieved from: https://www.who.int/nutrition/topics/obesity/en/

 

World Health Organization (WHO). (2011). WHO | Waist Circumference and Waist–Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008., (December), 8–11. Retrieved from: http://www.who.int

Lecturas: Educación Física y Deportes, Vol. 25, Núm. 268, Sep. (2020)