Considerations for Initiating and Progressing Running Programs in Obese Individuals

Abstract

Running has rapidly increased in popularity and elicits numerous health benefits, including weight loss. At present, no practical guidelines are available for obese persons who wish to start a running program. This article is a narrative review of the emerging evidence of the musculoskeletal factors to consider in obese patients who wish to initiate a running program and increase its intensity. Main program goals should include gradual weight loss, avoidance of injury, and enjoyment of the exercise. Pre-emptive strengthening exercises can improve the strength of the foot and ankle, hip abductor, quadriceps, and trunk to help support the joints bearing the loads before starting a running program. Depending on the presence of comorbid joint pain, nonimpact exercise or walking (on a flat surface, on an incline, and at high intensity) can be used to initiate the program. For progression to running, intensity or mileage increases should be slow and consistent to prevent musculoskeletal injury. A stepwise transition to running at a rate not exceeding 5%-10% of weekly mileage or duration is reasonable for this population. Intermittent walk-jog programs are also attractive for persons who are not able to sustain running for a long period. Musculoskeletal pain should neither carry over to the next day nor be increased the day after exercising. Rest days in between running sessions may help prevent overuse injury. Patients who have undergone bariatric surgery and are now lean can also run, but special foci such as hydration and energy replacement must be considered. In summary, obese persons can run for exercise, provided they follow conservative transitions and progression, schedule rest days, and heed onset of pain symptoms.

Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial

“…The aerobic training part will be conducted on a treadmill after strength training. Previous findings recommend that obese individuals can briskly walk or even run, provided they follow conservative transitions and progression, schedule rest days and heed onset of pain symptoms [34]. For progression to running, intensity or mileage increases should be slow and consistent to prevent musculoskeletal injury.…”

Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

“…Examples of this include aquatic treadmill, cycle or pool exercise classes, elliptical machines, or Nordic ski machines. Fourth, sustained or continuous exercise may be more uncomfortable than several smaller exercise bouts 109 to accumulate the cardiovascular or strength stimulus necessary to accumulate benefit and pain relief. Longer bouts of sustained low- or moderate-intensity exercise may prolong pain, but shorter more intense exercise may decrease the load-bearing exposure time.…”

“…This threshold has been proposed to permit bone tissues to “rest” and avoid mechanical failure. 109 Studies that determine the reasons for obese persons failing to maintain exercise levels with or without pain relief would help practitioners identify obese patients who may need additional interventions to promote adherence.…”

“…Exercise-induced joint pain should not persist or increase by 24 hours after exercise, which is an indication that the musculoskeletal system was not prepared for the exercise, or physical days will permit the individual to make a self-assessment of the pain response. 109 If an obese person with preexisting mild joint pain starts activity (<3 points out of a 10-point scale), similar guidelines apply: the pain should not worsen during the exercise session or last into the next day. If the pain causes a limp or a compensatory gait change, the exercise volume must be reduced, or the exercise must be stopped until a normal gait pattern is achieved.…”

“…It has been suggested that strengthening exercise or RX be initiated prior to starting a formal AX program to help develop muscle strength, joint support, and stability. 109 Control of exercise pain and functional ability may foster enjoyment of exercise and better adherence.…”