Module 3: Developing an Active Lifestyle

  • Riccardo Dalle Grave
  • Massimiliano Sartirana
  • Marwan El Ghoch
  • Simona Calugi


An active lifestyle plays a central role in the management of obesity, favouring the maintenance of weight loss and reducing the health risk associated with the condition. Unfortunately, however, most patients with obesity have little motivation to change their physical activity habits, and their adherence to exercise is further hampered by several physical, psychological and environmental barriers. The key role of these processes in the failure–success of exercise adherence suggests that without taking them into account, a simple traditional prescriptive approach to exercising is insufficient to produce long-term lifestyle alteration. With this in mind, Module 3 of cognitive behavioural therapy for obesity (CBT-OB) includes three main sections, described in detail below. The first prepares and motivates each patient to develop an active lifestyle and includes procedures to assess their eligibility and functional exercise capacity. The second involves a CBT-OB-recommended physical activity programme, and the third adopts several strategies for increasing patients’ adherence to exercise.


  1. 1.
    Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev. 2009;10(3):313–23. Scholar
  2. 2.
    Mayo MJ, Grantham JR, Balasekaran G. Exercise-induced weight loss preferentially reduces abdominal fat. Med Sci Sports Exerc. 2003;35(2):207–13. Scholar
  3. 3.
    Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222s–5s.CrossRefPubMedGoogle Scholar
  4. 4.
    Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. 2002;347(10):716–25. Scholar
  5. 5.
    Richardson CR, Kriska AM, Lantz PM, Hayward RA. Physical activity and mortality across cardiovascular disease risk groups. Med Sci Sports Exerc. 2004;36(11):1923–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Katzmarzyk PT, Church TS, Janssen I, Ross R, Blair SN. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care. 2005;28(2):391–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. Scholar
  8. 8.
    Canadian Society for Exercise Physiology. Physical Activity Readiness Questionnaire—PAR-Q. Revised 2002.
  9. 9.
    Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med. 2003;167(9):1287. Scholar
  10. 10.
    El Ghoch M, Rossi AP, Calugi S, Rubele S, Soave F, Zamboni M, Chignola E, et al. Physical performance measures in screening for reduced lean body mass in adult females with obesity. Nutr Metab Cardiovasc Dis. 2018.
  11. 11.
    Hamilton A, Balnave R, Adams R. Grip strength testing reliability. J Hand Ther. 1994;7(3):163–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test. Phys Ther. 2005;85(10):1034–45.PubMedGoogle Scholar
  13. 13.
    Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):M192–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Dalle Grave R. Motivating patients with obesity to exercise. In: Hansen D, editor. Exercise therapy in adult obesity. New York: Nova Press; 2013. p. 167–82.Google Scholar
  15. 15.
    Ballor DL, Poehlman ET. Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding. Int J Obes Relat Metab Disord. 1994;18(1):35–40.PubMedGoogle Scholar
  16. 16.
    Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Suppl):S547–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Jeffery RW, Wing RR, Sherwood NE, Tate DF. Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr. 2003;78(4):684–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. JAMA. 1999;282(16):1554–60.CrossRefPubMedGoogle Scholar
  19. 19.
    Andersen RE, Wadden TA, Bartlett SJ, Zemel B, Verde TJ, Franckowiak SC. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA. 1999;281(4):335–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Campbell A, Hausenblas HA. Effects of exercise interventions on body image: a meta-analysis. J Health Psychol. 2009;14(6):780–93. Scholar
  21. 21.
    Sherwood NE, Jeffery RW. The behavioral determinants of exercise: implications for physical activity interventions. Annu Rev Nutr. 2000;20:21–44. Scholar
  22. 22.
    Ekkekakis P, Lind E, Vazou S. Affective responses to increasing levels of exercise intensity in normal-weight, overweight, and obese middle-aged women. Obesity (Silver Spring). 2010;18(1):79–85. Scholar
  23. 23.
    Jakicic JM, Rogers RJ. Exercise in the management of obesity. In: Brownell KD, Walsh BT, editors. Eating disorders and obesity: a comprehensive handbook. 3rd ed. New York: Guilford Press; 2017. p. 546–50.Google Scholar
  24. 24.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc. 2007;107(1):92–9. Scholar
  26. 26.
    Dalle Grave R, Calugi S, El Ghoch M. Increasing adherence to diet and exercise through cognitive behavioural strategies. In: Lenzi A, Migliaccio S, Donini LM, editors. Multidisciplinary approach to obesity. Cham: Springer International Publishing; 2015. p. 327–35.CrossRefGoogle Scholar
  27. 27.
    Soave F. Strategie per adottare uno stile di vita attivo e per migliorare la fitness fisica. Emozioni e Cibo. 2014;39:18–20.Google Scholar
  28. 28.
    Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174(6):801–9. Scholar
  29. 29.
    Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Marcus BH, Simkin LR. The transtheoretical model: applications to exercise behavior. Med Sci Sports Exerc. 1994;26(11):1400–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.Google Scholar
  32. 32.
    Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q. 1986;13(1):73–92. Scholar
  33. 33.
    Muraven M, Baumeister RF. Self-regulation and depletion of limited resources: does self-control resemble a muscle? Psychol Bull. 2000;126(2):247–59.CrossRefPubMedGoogle Scholar
  34. 34.
    Sears SR, Stanton AL. Expectancy-value constructs and expectancy violation as predictors of exercise adherence in previously sedentary women. Health Psychol. 2001;20(5):326–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Jones F, Harris P, Waller H, Coggins A. Adherence to an exercise prescription scheme: the role of expectations, self-efficacy, stage of change and psychological well-being. Br J Health Psychol. 2005;10(Pt 3):359–78. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Dalle Grave
    • 1
  • Massimiliano Sartirana
    • 1
  • Marwan El Ghoch
    • 1
  • Simona Calugi
    • 1
  1. 1.Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly

Personalised recommendations