Mission Slimpossible!
Introduction
In the UK obesity is on its rise and there is an increased concern to whether there are any efficient
strategies to halt the problem. The U.S is estimated to be a decade ahead in terms of the evergrowing rise in obesity levels which is in-turn drastically increasing the rate of type 2 diabetes.
Results show obesity contributes to £3.5bn in economy costs, 30,000 deaths and 18 million days off
sick from work each year. It can also lead to major health problems such as diabetes, hypertension
and several more. Obesity is an overabundance of body fat and can be defined in relation to body
mass index (BMI), a BMI value >30 indicates an individual is obese and is reflected by an increased
waist circumference (Haslam, Sattar, & Lean, 2006).
Therefore, effective exercise prescription is essential to help with weight gain prevention and weight
loss maintenance, although it is evident that encouraging obese individuals to partake in physical
activity (PA) isn’t an easy task. Often people who are overweight or obese suffer from low selfesteem, possible eating disorders, depression, and anxiety (Ehrman, Gordon, Visich, & Keteyian,
2018). Low adherence to exercise is a common problem and can be due to high levels of displeasure,
research states individuals perform better with self-selected intensities which elicit a more
pleasurable response (Ekkekakis, 2009).
Multi-component behavioural weight management programs (BWMP) have been developed and
widely used most abundantly in primary care settings, they address physical activity, nutrition, and
behaviour therapy, although, these programs have seen to have varied outcomes. Loveman, et al.,
(2011) conducted a systematic review on the effectiveness of long=term weight management
schemes for adults and found the interventions had generally produced modest weight loss in
overweight or obese subjects, however weight regain was common, additionally these interventions
were likely to be cost-effective. An update review with a more calloborative approach used by NICE,
(2013) reported the effectiveness of 44 different BWMP’s compared to control coniditons,
participants in the control condition had produced acute weight loss over a 12+ month period,
whereas the intervention groups produced signifcantly greater results in most cases, 2-3kg more
weight reducution in a 12-18 month period. There had also been evidence that suggests
interventions involving face-to-face contact, set goals and supervised exercise yielded the most
benefit compared to other interventions, this indicates the the potential necessity for assistance and
contact to elciit greater results. Overall, BWMP’s may play a crucial role in the assistance of adopting
a healthier and active lifestyle.
Referral Criteria
Participants will be eligible for the program if they match the referral criteria, this criterion is
evidence based using the guidelines associated with ACSM, (2013). Their body mass index (BMI)
should indicate that they’re overweight or obese, 25 – 29.9 kg/m2 (overweight), ≥30kg/m2 (obese).
In addition to BMI, waist girth measurements will also be taken, an obese individual will be
measured at a waist girth >102cm(40inch) for men and >88cm(35inch) for women (Executive
summary of the clinical guidelines, 1998).
Old age, physical inactivity and race are some of the factors that can contribute to hypertension,
participants may be referred if they have levels above normal, SBP – 120-139/ DBP – 80-89
(Prehypertension), Stage 1 & 2 hypertension are excluded from criteria.
An unhealthy diet with an abundant quantity of processed foods containing high saturated fat or
trans fats can increase cholesterol levels – leading to dyslipidaemia. Participants may be referred if
their LDL cholesterol is 130-159 mg∙dL-1, total cholesterol is 200-239 mg∙dL-1 , HDL cholesterol ≥60
mg∙dL-1 and triglycerides are 150-199 mg∙dL-1 .
Individuals at risk of Type 2 Diabetes with fasting plasma glucose levels exceeding optimal levels are
also considered, this is largely subject to an individual’s weight and waist circumference which can
lead to insulin resistance. Prediabetic plasma glucose ranges from 100 mg∙dL-1 to 125 mg∙dL-1 for
impaired fasting glucose and 140 mg∙dL-1 to 199 mg∙dL-1 for impaired glucose tolerance. Individuals
with higher values than prediabetic values will more than likely be diabetic and therefore excluded
from the criteria.
Cardiovascular disease (CVD) potential is exacerbated due to all above criteria; therefore, all are
leading causes of CVD. Additionally, cigarette smoking (or recent cessation/ in the last 6 months) and
sedentary lifestyle behaviours (failure to partake in at least 30 min of moderate intensity exercise 3
times per week) are considered lifestyle factors that may lead to increased risk of CVD – and are also
considered as referral criteria for this program.
Workshop entry process and progress monitoring
Pre-Participation - Health Screening
Participants are required to complete a range of pre-participation processes that indicate the
physical readiness of the individual and to consider any metabolic complications one may have
before engaging in physical activity. Following a similar approach to ACSM, (2013), there will be a
multistage process, including AHA/ACSM Health/Fitness Facility Preparticipation Screening
Questionnaire ACSM, (2009), an informed consent, a CVD risk factor assessment and classification,
and medical evaluation (if required) that involves a physical examination and stress test by a
reputable health care professional. All individuals will be required to complete at minimum, the
health screening questionnaire and informed consent form.
The AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire (see figure 1),
allows individuals with multiple CVD risk factors to be properly assessed by a professional prior to
engaging in physical activity, this is mandatory as part of regular effective medical practice and
should progress incrementally alongside their prescribed exercise program (ACSM, 2009).
A CVD risk factor assessment allows the health care professional to acquire relevant information
regarding the patient’s development and on-going progression/regression. Determining the
presence of metabolic and cardiovascular disease is essential for when making decisions regarding
the level of medical clearance, the need for exercise testing and the level of exercise supervision and
exercise frequency (ACSM, 2013).
The informed consent is required before exercise in any health/fitness or clinical setting, this
documentation is an important part of ethical and legal consideration. The form allows the
participant to understand what is required of them and the purpose and risks associated with the
exercise test/program (ACSM, 2013).
Figure 1
AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire
Note: Adopted from American College of Sports Medicine. (2013). ACSM's guidelines for exercise
testing and prescription. Lippincott Williams & Wilkins. p25, fig 2.2.
Figure 2 and 3 adopted from ACSM, (2013) are representative of the CVD assessments that the
health practioner will require from each patient. This is necessary to identify the level of risk which
will therefore determine the exercise regime. For example, if the patient has numerous CVD risk
factors (≥2) they will likely be classified as moderate or high risk, or a combination of both, in this
case, with the given referral criteria, the individuals will more than likely be classified as moderate
risk. This can then be progressed to identify which level of intensity is or isn’t advised when working
with patients, In Figure 3, this model allows the practioner to address whether a medical
examination, exercise test and physician supervision are necessary for pre-participation health
screening, however, if not required, the patient may still be eligible to request the examination if
they believe they’re at risk.
Figure 2
Logic model for classification of risk
Note: Adopted from American College of Sports Medicine. (2013). ACSM's guidelines for exercise
testing and prescription. Lippincott Williams & Wilkins. p26, fig 2.3.
Figure 3
Medical examination based on risk classification
Note: Adopted from American College of Sports Medicine. (2013). ACSM's guidelines for exercise
testing and prescription. Lippincott Williams & Wilkins. p28, fig 2.4.
If the patient has answered the CV assessment (see figure 2) and shows signs of metabolic
complications, they will be required to consult a physician prior to starting an exercise program,
there is evidence that if an individual of whom is unaccustomed to PA and performs bouts of
vigorous intensity exercise, the likelihood of an exercise-related event such as sudden cardiac death
or acute MI is increased (Giri, et al., 1999; Siscovick, et al., 1984). Therefore, the most appropriate
approach would be to start with light-to-moderate intensity levels of exercise and progress
incrementally as their physical fitness increases.
Pre-participation – Assessments (Physiological, Psychological & Nutrition)
Once the patient has completed their initial step within the pre-participation process, they will then
be taken through various assessments that will be repeated throughout the 12-week intervention,
patients will be required to take part in the tests at the start, after six weeks and the twelfth week –
totalling three compulsory testing events. The patients will be asked to participate in a 6-month
follow up post-intervention to highlight the long-term effects and thus asked to repeat all the range
of assessments below to evaluate the long-term health effects of this program.
Blood Pressure (BP)
Patients will have their blood pressure measurement taken before exercise participation. This is an
important factor to consider when addressing an individual’s health and well-being. Prehypertensive
individuals included in the referral criteria require health-promoting lifestyle alterations to prevent
the progressive rise in blood pressure, as this indefinitely increases the likelihood of developing CVD
(Chobanian, et al., 2003). As this intervention involves overweight and obese patients, they will most
likely need modifications when undergoing a blood pressure test, one main modification is that the
individual will likely require a larger cuff size. Measurement of blood pressure will follow the same
methodology from Prineas, (1991).
It is expected that, by the halfway point of the program, patients will see a decrease in their BP, with
further reductions by the end point of 12 weeks, with the future expectation to return to normal
levels (<120 mm Hg SBP, <80 mm Hg DBP) (ACSM, 2013). Numerous substantial epidemiological
studies have shown that a reduction in weight leads to a BP lowering effect, likely due to improving
insulin sensitivity (Mertens and Van Gaal, 2000).
Cholesterol Levels
Next, the patients will be required to have their blood taken to examine cholesterol levels NHS
(2019), with the aim to reduce low-density lipoproteins (LDL), as this is a major risk factor for CVD,
thus lowering LDL results in a significant reduction in the incidence of CVD (12), further, to increase
the levels of high-density lipoproteins (HDL) to combat the chances of developing CVD (ACSM, 2013).
Smoking, overweight/obese status, sedentary lifestyle, and poor nutrition habits all contribute to the
raise in cholesterol levels (NHS, 2019). The program hopes to reduce cholesterol levels, seeing a
decline by week 6 and further reductions by week 12 – with the expectation to reach normal levels
by the end of the intervention. Normal levels = LDL – 100-129 mg∙dL-1, Total cholesterol <200 mg∙dL1
, HDL – 40-60 mg∙dL-1, Triglycerides <150 mg∙dL-1 (NCEP, 2004).
Plasma Glucose Levels
Testing for glucose levels can be done via blood samples NHS (2020), like testing for cholesterol
levels, therefore both can be checked simultaneously. Prediabetic patients within this program will
have both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) and are at a
significantly high risk for developing diabetes (10).
Reduction in weight can make it easier to achieve a lower blood sugar level, leading to improved
insulin response and sensitivity, this program aims to reduce body weight and improve blood sugar
levels week by week with appropriate diet and exercise. By the end of the 12 weeks, the patient will
have lowered both (IGT & IFG) levels appropriately, aiming for close to 100 mg∙dL-1.
Anthropometric Measures
Patients would have already identified their BMI and waist circumference (WC) prior to joining the
program, their BMI and (WC) will be recorded at the point of starting the program, in the middle and
at the end (1,6,12 weeks). Along with BMI, circumference measures will be taken by the practioners
using a measuring tape, measures of the waist, upper arm, hips, calf, mid-thigh, neck, and calf will all
be required for recording at the same intervals throughout the program (1,6,12 weeks). Using the
same methodology seen in the manual of Callaway and colleagues, (1988). It is essential that all
patients achieve reduction in girth measurements, with the addition of a lower BMI score
throughout the program, with the emphasis of reducing WC to prevent the probability of CVD,
hypertension, diabetes, and early death (Pi-Sunyer, 2004). According to the guidelines addressed by
ACSM (2013), normative values of WC for men and female are as follows: 28.5–35inch / 31.5–
39.0inch, therefore these values will be the target for individuals of this program, achieving a
reduction in both BMI and WC respectfully.
Resting Heart Rate (RHR)
In addition to the measures above, practioners will need to take a resting heart rate from all
participants, this is not included in the referral criteria, so a varied range of RHR are expected.
However, it is known that a RHR ≥90 beats per min(bpm) compared to <60bpm yields at least a twofold increase in CVD mortality, the method associated with taken RHR is adopted from Cooney, et
al., (2010).
6 Minute Walk Test (6MWT)
To test exercise capacity, this program will involve a 6-minute walk test, the distance the individual
covers is the prime outcome measure of the test, secondary measurements will include fatigue and
dyspnoea that will be rated via a borg scale Williams (2017), and will be administered at the start,
middle and end of the intervention. The method for this specific test is adopted from Enright (2003)
and inherits a non-intrusive approach to gaining knowledge as to where the patient is in terms of
their fitness level. Furthermore, this test requires no equipment and can be performed anywhere if
the patient has a means of recording distance travelled via electronic device plus a stopwatch.
The table below contains an equation that is an acceptable method to predict VO2 peak from the
6MWT:
Table 1:
VO2 peak equation
Note: Adopted from Cahalin, et al., (1996)
Strength Testing
To test muscular strength, a gym facility will be used, all participants will partake in a six-repetition
max test (6RM) using both a leg press and chest press machine. They will be supervised by a
practioner to ensure adequate technique and methodology behind the test will be adopted from
Logan and colleagues (2000). A 6RM can be deemed more appropriate than singular maximal rep
due to the population used for this study; as they’re at risk to developing CVD and other health
conditions.
This test will commence at the start, middle and end of the exercise program, practioners will record
the weights lifted for each patient and the goal will be to increase the weight used for each future
test.
Psychological Testing/Questionnaire
Each patient will fill and complete a quality-of-life questionnaire (QOLQ) created by Moorehead and
colleagues (2003). It will be assigned to patients at the start and end of the intervention, this
questionnaire covers multiple areas of an individual’s life and can be used to assess whether some if
not all elements have improved. Further, the QOLQ can be completed in less than one minute, and
can be administer to patients via email,
Nutritional Analysis
Participants will be asked to provide a 3-day food diary at the start of the intervention for the health
practioner to assess, it is very likely that there should be amendments to the participants eating
habits to allow for progressive weight loss. The diary should provide all food and beverages with as
close to exact measures of each. This will then be analysed and feedback will be provided during the
intervention.
12-Week Program Content and Delivery
Week 1:
Day 1
Day 2
• Screening &
Testing (3
Hours)
• Group
Nutrition
Class (2hours)
Day 3
• Group GymBased
Exercise
(60min)
Day 4
• 1-to-1 with
practioner
(motivational
interviewing)
Day 5
• Self-pace
walk ≥10mins
Day 6
• Self-pace
walk ≥10mins
Week 2:
Day 1
Day 2
• Online
Educational
Material
• Self-pace
walk ≥10mins
Day 3
• Online
Educational
Material
Day 4
• Group GymBased
Exercise
(60min)
Day 5
• Self-pace
walk ≥10mins
Day 6
• Self-pace
walk ≥10mins
Week 3:
Day 1
• 1-to-1 with
practioner
(motivational
interviewing)
Day 2
• Group GymBased
Exercise
(60min)
Day 3
• Group
Nutrition
Class (2hours)
Day 4
• Self-pace
walk ≥10mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• Online
Educational
Material
Week 4:
Day 1
Day 2
• Self pace
walk ≥10mins
Day 3
• Group GymBased
Exercise
(60min)
Day 4
• Online
Educational
Material
Day 5
• Self-pace
walk ≥10mins
Day 6
• Group GymBased
Exercise
(60min)
• Self-pace
walk ≥10mins
Week 5:
Day 1
Day 2
• 1-to-1 with
practioner
(motivational
interviewing)
+ Self pace
walk ≥15mins
Day 3
• Group GymBased
Exercise
(60min)
Day 4
Day 5
• Self-pace
walk ≥15mins
• Group
Nutrition
Class
(2hours)
Day 6
• Group GymBased
Exercise
(60min)
• Self-pace
walk ≥10mins
+ Online
Educational
Material
Week 6:
Day 1
Day 2
• Screening &
Testing (3
Hours)
• Group GymBased
Exercise
(60min)
Day 3
• Online
Educational
Material +
Self-pace
walk ≥10mins
Day 4
• Self-pace
walk ≥10mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• Self-pace
walk ≥10mins
Week 7:
Day 1
Day 2
• Self-pace
walk ≥15min
+ Online
Educational
Material
• Group GymBased
Exercise
(60min)
Day 3
• Group
Nutrition
Class
(2hours)
Day 4
• Self-pace
walk ≥15mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• 1-to-1 with
practioner
(motivational
interviewing)
+ Self pace
walk ≥15mins
Week 8:
Day 1
Day 2
• Online
Educational
Material
• Group GymBased
Exercise
(60min)
Day 3
• Self-pace
walk ≥15mins
Day 4
• Self-pace
walk ≥15mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• + Self pace
walk ≥15mins
Week 9:
Day 1
• Group
Nutrition
Class
(2hours)
Day 2
• Group GymBased
Exercise
(60min)
Day 3
• Self-pace
walk ≥20mins
Day 4
• Self-pace
walk ≥15mins
+Online
Educational
Material
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• 1-to-1 with
practioner
(motivational
interviewing)
+ Self pace
walk ≥15mins
Week 10:
Day 1
Day 2
• Self-pace
walk ≥15mins
• Group GymBased
Exercise
(60min)
Day 3
• Online
Educational
Material
Day 4
• Self-pace
walk ≥15mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• + Self pace
walk ≥20mins
Week 11:
Day 1
Day 2
• 1-to-1 with
practioner
(motivational
interviewing)
+ Self- pace
walk≥15mins
• Group GymBased
Exercise
(60min)
Day 3
• Group
Nutrition
Class
(2hours)
Day 4
• Online
Educational
Material
+Self pace
walk ≥20mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• + Self pace
walk ≥20mins
Week 12:
Day 2
Day 1
• Screening &
Testing (3
Hours)
• Group GymBased
Exercise
(60min)
Day 3
• Online
Educational
Material +
Self-pace
walk ≥10mins
Day 4
• Self-pace
walk ≥20mins
Day 5
• Group GymBased
Exercise
(60min)
Day 6
• Self-pace
walk ≥20mins
+ 1-to-1 with
practioner
(motivational
interviewing)
Break-down of Intervention
The 12-week intervention above focuses on achieving a modest weight loss goal of 5-10% of the
individual’s current weight, this plan comprises of several elements, targeting physical activity,
nutritional education, progress monitoring and 1-to-1 behavioural management. Additionally,
participants will be expected to move through different stages of change using the psychological
model known as the Transtheoretical Model, Prochaska and Velicer (1997) an accurate presumption
of the individual’s stage at the beginning of the intervention would include having initial thoughts
about starting a weight loss program and has some knowledge of the pros and cons – they may have
difficulties with committing to a long-term change and persists to have mixed feelings about a
healthier way of life. This indicates the individual would be starting within the contemplation stage,
this plan aims to progress the person/s to the maintenance stage, with a future aspiration for them
to maintain positive habits (action stage).
This plan seeks to use processes that are both behavioural and experiential to support the individual
in their growth and to adopt healthier habits.
Experiential:


Consciousness Raising (Increasing awareness)
o Self-evaluation questionnaire, using the QOLQ
o Health education via online nutrition course
Social Liberation
o Gym discounts for patients participating in the program
o Provision by health care professionals
Behavioural:


Helping Relationships (Supporting)
o Group resistance exercise
o 1-to-1 motivational interviewing
o Support from exercise trainer
Reinforcement Management (Rewarding)
o Goal setting, 5-10% weight loss in 12 weeks
o Individual goals, 3-month free gym membership if achieved 5-10% weight loss in 12
weeks
Health Screening & Testing
Patients will partake in health screening along with both aerobic and strength tests at three intervals
within the intervention: the start, middle and end. This will take place in a local health practice and
all patients eligible for the plan will be scheduled throughout the day.
Group Nutrition Class/Workshop
Nutrition workshops/seminars will be delivered via a nutrition specialist which will take place in a
local community hall that has access to kitchen facilities. Within 2-hour period, patients will be able
to socialise and talk about their personal barriers to healthy eating and have a chance to prepare
and cook healthy meals instructed by the specialist. Nutrition education is a significantly important
factor that is associated with health and well-being, previous studies have evaluated and confirmed
the benefit of nutrition education (Au, et al., 2016; Wagner, et al., 2016). At the end of each
workshop, the specialist will hand out informative material to promote healthy eating habits to each
participant.
The specialist will also encourage all participants to start tracking their food via MyFitnessPal App on
mobile devices MyFitnessPal, (2022), and aim for a 500-calorie deficit, this can also be achieved via
exercise, however a combination of exercise and food intake to produce a negative caloric balance is
advised (Donnely, et al., 2009).
Part-Time Online Nutrition Course
To gain more of an understanding on the topic of healthy eating, the program will enrol all
participants on an online nutrition course, this will be a part time course that lasts the duration of
the intervention and will act as supplementary element to their learning.
The course will be running by a renowned organisation named ‘Vision2learn’ and will go through
topic areas such as Vision2learn, (2022):






The principles of healthy eating
The nutritional needs of individuals
Planning a healthy diet
Principles of weight management
Understanding eating disorders
Principles of food safety for the home environment
Group-Based Resistance Training
All participants are required to engage in physical activity, both aerobic (walking) and anaerobic (RT),
as part of the exercise regime, a group-based resistance exercise routine will be prescribed under
supervision by an exercise professional. This will take place in a private health centre gym that
allows access to groups and has access to numerous fitness equipment.
To give sense of togetherness and not isolation, the program encourages group-based exercise twice
per week, every week. This is to build a social network, cohesion and thus improve self-efficacy
beliefs via mutual support Christensen, et al (2006), both male and female participants in previous
studies using a group exercise protocol benefitted with more positive psychological effects, feeling
calmer, however the potential for competition may be apparent with other participants around,
resulting in more tiredness (Plante, et al., 2001). Although this could be a benefit due to higher
workloads. Furthermore, exercising in groups has be shown to elicit forms of social support in which
strengthen exercise identity (Golaszewski, et al., 2021).
The prescribed exercise program will include up to 10 different exercises; chest press, shoulder
press, triceps extension, biceps curl, pulldowns, lower-back extension, ab crunch, leg press, leg curl
and calf raise and should elicit a desirable outcome and improvement (Pollock, et al., 2000). Lack of
time may be a barrier for some individuals due to lifestyle factors, so a single set of each exercise to
volitional fatigue (8-12 repetitions, moderate intensity), with weight loads associated 50-60% of 1RM
has been found as effective as multiple-set plans, thus the session may only last 20-30 minutes
ACSM (1998), although being in a group scenario, this may take a little longer. The professional will
record weights use and encourage the participants to incrementally increase weight/load over time.
RT has shown to have a vast array of benefits, including enhancing cardiorespiratory fitness and
improving body composition. Recent seminal research demonstrated that RT positively affects risk
factors such as insulin resistance, resting metabolic rate, glucose metabolism, blood pressure and
body fat (Winett and Carpinelli 2001). The same study also indicates almost all benefits from RT are
likely obtained within the first 20 minutes of training, twice per week. Furthermore, Honkola, et al.,
1997 reported than during circuit training RT, LDL cholesterol and fasting triglycerides were reduced compared
with no exercising group, the results are parallel with that of Westcott, (2012) too.
Self-Paced Walking
Aerobic exercise is an important asset to one’s health and has been administered as self-pace
walking (low intensity) on certain days with time progressions throughout the intervention, starting
from 10 to 20-minute sessions. Aerobic exercise is a vital part of an exercise program, and has
numerous health benefits, improving glucose control, improving insulin sensitivity, and improving
CVD risk factors (Boulé, et al., 2001; Mourier, et al., 1997). The combination of both walking and RT
exercise generate positive effects, Balducci, et al., (2004) demonstrated that a long-term
intervention pairing both aerobic and RT exercise significantly improved metabolic and lipid profiles,
adiposity, and blood pressure also, and when compared to a non-exercise group, fat mass was
reduced, while fat-free mass was increased. In addition, fasting blood glucose, LDL cholesterol and
total cholesterol were greatly reduced, while HDL cholesterol was increased.
The program encourages self-selected pace walking to enhance the element of pleasure, overweight
and obese individuals tend to experience feelings of displeasure when prescribed a specific intensity,
and over time this could reduce adherence due to diminishing enjoyment (Ekkekakis and Lind, 2006).
To further increase enjoyment and satisfaction, the participant can walk outdoors, this is known to
increase symptoms of pleasure and distraction, reducing overall feelings of exertion (Krinski, et al.,
2017).
Recommended Exercise Guidelines
Determined by the exercise instructor, the program is designed to gradually increase the time spent
performing PA, in week one the prescribed amount of PA starts with just 80 minutes, after weeks of
gradual increase, the amount of PA has increased to 170 minutes by week 12. This end figure
represents an amount that is slightly greater than the recommended weekly PA, which is 150
minutes, this is justified as the minimum PA dose for significant health benefits Participants will be
encouraged to continue their exercise plan after the intervention, gradually increasing to 200 minutes
minimum PA per week to facilitate long-term maintenance of weight loss (Donnely, et al., 2009).
1-to-1 Motivational Interviewing
Addressed by a weight management psychologist, this technique is used to address behavioural
changes by improving intrinsic motivation and focusing on doubt and uncertainty (Barnes, 2015). The
main topic of the 1-to-1 will be to discuss ‘change talk’, based on reasons and potential barriers to change, in a
supportive setting.
Other topics will include disinhibited eating, binge eating, eating in response to emotional states,
being held accountable, internal motivators and self-efficacy (Greif and Miranda, 2010). Further,
encouraging feelings of self-worth or self-efficacy can assist individuals in their self-belief. Building
rapport with the participants in this intervention will increase adherence and much needed trust.
References
American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for
developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.
(1998). Medicine and science in sports and exercise, 30(6), 975–991.
https://doi.org/10.1097/00005768-199806000-00032
American College of Sports Medicine. (2013). ACSM's guidelines for exercise testing and prescription.
Lippincott Williams & Wilkins. ISBN 978-1-60913-605-5
American College of Sports Medicine, Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C.
T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009). American College of Sports Medicine position
stand. Exercise and physical activity for older adults. Medicine and science in sports and exercise,
41(7), 1510–1530. https://doi.org/10.1249/MSS.0b013e3181a0c95c
Au, L. E., Whaley, S., Rosen, N. J., Meza, M., & Ritchie, L. D. (2016). Online and In-Person Nutrition Education
Improves Breakfast Knowledge, Attitudes, and Behaviours: A Randomized Trial of Participants in the
Special Supplemental Nutrition Program for Women, Infants, and Children. Journal of the Academy
of Nutrition and Dietetics, 116(3), 490–500. https://doi.org/10.1016/j.jand.2015.10.012
Balducci, S., Leonetti, F., Di Mario, U., & Fallucca, F. (2004). Is a long-term aerobic plus resistance training
program feasible for and effective on metabolic profiles in type 2 diabetic patients? Diabetes care,
27(3), 841–842. https://doi.org/10.2337/diacare.27.3.841
Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among
adults in primary care. Obesity reviews: an official journal of the International Association for the
Study of Obesity, 16(4), 304–318. https://doi.org/10.1111/obr.12264
Boulé, N. G., Haddad, E., Kenny, G. P., Wells, G. A., & Sigal, R. J. (2001). Effects of exercise on glycemic
control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA,
286(10), 1218–1227. https://doi.org/10.1001/jama.286.10.1218
Cahalin, L. P., Mathier, M. A., Semigran, M. J., Dec, G. W., & DiSalvo, T. G. (1996). The six-minute walk test
predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest, 110(2), 325–
332. https://doi.org/10.1378/chest.110.2.325
Callaway CW, Chumlea WC, Bouchard C, Himes JH, Lohman TG, Martin AD. Circumferences. In: Lohman TG,
Roche AF, Martorell R, editors. Anthropometric Standardization Reference Manual. Champaign:
Human Kinetics; 1988. p. 39–80. https://doi.org/10.1080/00140138808966796.
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr, Jones, D. W., Materson,
B. J., Oparil, S., Wright, J. T., Jr, Roccella, E. J., National Heart, Lung, and Blood Institute Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, & National
High Blood Pressure Education Program Coordinating Committee (2003). The Seventh Report of the
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure: the JNC 7 report. JAMA, 289(19), 2560–2572. https://doi.org/10.1001/jama.289.19.2560
Christensen, U., Schmidt, L., Budtz-Jørgensen, E., & Avlund, K. (2006). Group Cohesion and Social Support in
Exercise Classes: Results From a Danish Intervention Study. Health Education & Behavior, 33(5), 677–
689. https://doi.org/10.1177/1090198105277397
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The
Evidence Report. National Institutes of Health. (1998). Obesity research, 6 Suppl 2, 51S–209S.
ttps://doi.org/10.1016/s0002-8223(98)00276-4
Cooney, M. T., Vartiainen, E., Laatikainen, T., Juolevi, A., Dudina, A., & Graham, I. M. (2010). Elevated resting
heart rate is an independent risk factor for cardiovascular disease in healthy men and women.
American heart journal, 159(4), 612–619.e3. https://doi.org/10.1016/j.ahj.2009.12.029
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., Hu, F. B., Kahn, C. R., Raz, I.,
Shulman, G. I., Simonson, D. C., Testa, M. A., & Weiss, R. (2015). Type 2 diabetes mellitus. Nature
reviews. Disease primers, 1, 15019. https://doi.org/10.1038/nrdp.2015.19
Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., Smith, B. K., & American College of
Sports Medicine (2009). American College of Sports Medicine Position Stand. 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. https://doi.org/10.1249/MSS.0b013e3181949333
Ehrman, J. K., Gordon, M. P., Visich, P. S., & Keteyian, S. J. (2018). Clinical Exercise Physiology. Human
Kinetics, 282. ISBN:9781492546467
Ekkekakis P. (2009). Let them roam free? Physiological and psychological evidence for the potential of selfselected exercise intensity in public health. Sports medicine (Auckland, N.Z.), 39(10), 857–888.
https://doi.org/10.2165/11315210-000000000-00000
Ekkekakis, P., & Lind, E. (2006). Exercise does not feel the same when you are overweight: the impact of selfselected and imposed intensity on affect and exertion. International journal of obesity (2005), 30(4),
652–660. https://doi.org/10.1038/sj.ijo.0803052
Enright P. L. (2003). The six-minute walk test. Respiratory care, 48(8), 783–785. The Six-Minute Walk Test
(rcjournal.com)
Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight
and obesity in adults. (1998). Archives of internal medicine, 158(17), 1855–1867.
https://doi.org/10.1001/archinte.158.17.1855
Giri, S., Thompson, P. D., Kiernan, F. J., Clive, J., Fram, D. B., Mitchel, J. F., Hirst, J. A., McKay, R. G., & Waters,
D. D. (1999). Clinical and angiographic characteristics of exertion-related acute myocardial
infarction. JAMA, 282(18), 1731–1736. https://doi.org/10.1001/jama.282.18.1731
Glyn-Jones, S., Palmer, A. J., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015).
Osteoarthritis. Lancet (London, England), 386(9991), 376–387. https://doi.org/10.1016/S01406736(14)60802-3
Golaszewski, Natalie & LaCroix, Andrea & Hooker, Steven & Bartholomew, John. (2021). Group exercise
membership is associated with forms of social support, exercise identity, and amount of physical
activity. International Journal of Sport and Exercise Psychology. 1-14.
https://doi.org/10.1080/1612197X.2021.1891121
Grief, S. N., & Miranda, R. L. (2010). Weight loss maintenance. American family physician, 82(6), 630–634.
Haslam, D., Sattar, N., & Lean, M. (2006). ABC of obesity. Obesity--time to wake up. BMJ (Clinical research
ed.), 333(7569), 640–642. https://doi.org/10.1136/bmj.333.7569.640
Honkola, A., Forsén, T., & Eriksson, J. (1997). Resistance training improves the metabolic profile in individuals
with type 2 diabetes. Acta diabetologica, 34(4), 245–248. https://doi.org/10.1007/s005920050082
Krinski, K., Machado, D., Lirani, L. S., DaSilva, S. G., Costa, E. C., Hardcastle, S. J., & Elsangedy, H. M. (2017).
Let's Walk Outdoors! Self-Paced Walking Outdoors Improves Future Intention to Exercise in Women
With Obesity. Journal of sport & exercise psychology, 39(2), 145–157.
https://doi.org/10.1123/jsep.2016-0220
Logan P, Fornasiero D, Abernathy P. Protocols for the assessment of isoinertial strength. In:
Gore CJ, editor. Physiological Tests for Elite Athletes. Champaign: Human Kinetics; 2000.
p. 200–21.
Mertens, I. L., & Van Gaal, L. F. (2000). Overweight, obesity, and blood pressure: the effects of modest
weight reduction. Obesity research, 8(3), 270–278. https://doi.org/10.1038/oby.2000.32
Moorehead, M. K., Ardelt-Gattinger, E., Lechner, H., & Oria, H. E. (2003). The validation of the MooreheadArdelt Quality of Life Questionnaire II. Obesity surgery, 13(5), 684–692.
https://doi.org/10.1381/096089203322509237
Mourier, A., Gautier, J. F., De Kerviler, E., Bigard, A. X., Villette, J. M., Garnier, J. P., Duvallet, A., Guezennec,
C. Y., & Cathelineau, G. (1997). Mobilization of visceral adipose tissue related to the improvement in
insulin sensitivity in response to physical training in NIDDM. Effects of branched-chain amino acid
supplements. Diabetes care, 20(3), 385–391. https://doi.org/10.2337/diacare.20.3.385
Mertens, I. L., & Van Gaal, L. F. (2000). Overweight, obesity, and blood pressure: the effects of modest
weight reduction. Obesity research, 8(3), 270–278. https://doi.org/10.1038/oby.2000.32
Myfitnesspal.com. 2022. MyFitnessPal | MyFitnessPal.com. https://www.myfitnesspal.com [Accessed 9
January 2022].
NHS England, (2019). Cholesterol levels. High cholesterol - NHS (www.nhs.uk)
NHS England, (2020). Type 2 Diabetes. Type 2 diabetes - NHS (www.nhs.uk)
Pi-Sunyer F. X. (2004). The epidemiology of central fat distribution in relation to disease. Nutrition reviews,
62(7 Pt 2), S120–S126. https://doi.org/10.1111/j.1753-4887.2004.tb00081.x
Plante, T.G., Coscarelli, L. & Ford, M. Does Exercising with Another Enhance the Stress-Reducing Benefits of
Exercise?. International Journal of Stress Management 8, 201–213 (2001).
https://doi.org/10.1023/A:1011339025532
Pollock, M. L., Franklin, B. A., Balady, G. J., Chaitman, B. L., Fleg, J. L., Fletcher, B., Limacher, M., Piña, I. L.,
Stein, R. A., Williams, M., & Bazzarre, T. (2000). AHA Science Advisory. Resistance exercise in
individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: An
advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical
Cardiology, American Heart Association; Position paper endorsed by the American College of Sports
Medicine. Circulation, 101(7), 828–833. https://doi.org/10.1161/01.cir.101.7.828
Prochaska, J. O., & Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior
change. American journal of health promotion : AJHP, 12(1), 38–48. https://doi.org/10.4278/08901171-12.1.38
Prineas R. J. (1991). Measurement of blood pressure in the obese. Annals of epidemiology, 1(4), 321–336.
https://doi.org/10.1016/1047-2797(91)90043-c
Reynolds, J. M., Gordon, T. J., & Robergs, R. A. (2006). Prediction of one repetition maximum strength from
multiple repetition maximum testing and anthropometry. Journal of strength and conditioning
research, 20(3), 584–592. https://doi.org/10.1519/R-15304.1
Siscovick, D. S., Weiss, N. S., Fletcher, R. H., & Lasky, T. (1984). The incidence of primary cardiac arrest during
vigorous exercise. The New England journal of medicine, 311(14), 874–877.
https://doi.org/10.1056/NEJM198410043111402
Stamler J. (1991). Blood pressure and high blood pressure. Aspects of risk. Hypertension (Dallas, Tex. :
1979), 18(3 Suppl), I95–I107. https://doi.org/10.1161/01.hyp.18.3_suppl.i95
Stanner, Sara & Coe, Sarah & Frayn, Keith. (2019). Cardiovascular Disease: Diet, Nutrition and Emerging Risk
Factors, John Wiley & Sons Ltd Second Edition. 293-309. 10.1002/9781118829875.ch12.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) [Internet]. Bethesda
(MD): National Cholesterol Education Program; 2004 [cited Mar 19]. 284 p. Available from:
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
Treatment of High Blood Pressure: the JNC 7 report. JAMA, 289(19), 2560–2572.
https://doi.org/10.1001/jama.289.19.2560
Vision2learn. (2022). Capita Learning. https://www.vision2learn.net/
Wagner, M. G., Rhee, Y., Honrath, K., Blodgett Salafia, E. H., & Terbizan, D. (2016). Nutrition education
effective in increasing fruit and vegetable consumption among overweight and obese adults.
Appetite, 100, 94–101. https://doi.org/10.1016/j.appet.2016.02.002
Westcott W. L. (2012). Resistance training is medicine: effects of strength training on health. Current sports
medicine reports, 11(4), 209–216. https://doi.org/10.1249/JSR.0b013e31825dabb8
Williams, N. The Borg Rating of Perceived Exertion (RPE) scale, Occupational Medicine, Volume 67, Issue 5,
July 2017, Pages 404–405, https://doi.org/10.1093/occmed/kqx063
Winett, R. A., & Carpinelli, R. N. (2001). Potential health-related benefits of resistance training. Preventive
medicine, 33(5), 503–513. https://doi.org/10.1006/pmed.2001.0909