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Exercise prescription for the overweight and

the obese: how to quantify and yet keep it
simple
R Ehrsam, U Hoerler-Koerner, S Stoffel, et al.

Br J Sports Med 2009 43: 951-953 originally published online March 16,
2009
doi: 10.1136/bjsm.2008.055657

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c Supplemental table 2 and fig
2 are published online only at
http://bjsm.bmj.com/content/
vol43/issue12
1
Sports Medicine and
Rehabilitation Division, Zinman
College of Physical Education
and Sport Sciences, Wingate,
Israel; 2 Institute for Exercise and
Health Sciences, University of
Basel, Basel, Switzerland;
3
Department of Exercise and
Wellness, Arizona State
University, Politechnic Campus,
Mesa, Arizona, USA
Correspondence to:
Dr R Ehrsam, Sports Medicine
and Rehabilitation Division,
Zinman College of Physical
Education and Sport Sciences,
Wingate 42902, Israel; Rolf.
ehrsam@unibas.ch
Accepted 23 February 2009
Published Online First
16 March 2009
Br J Sports Med 2009;43:951–953. doi:10.1136/bjsm.2008.055657
Downloaded from bjsm.bmj.com on November 2, 2013 - Published by group.bmj.com
Exercise prescription for the overweight and the
obese: how to quantify and yet keep it simple
R Ehrsam,1 U Hoerler-Koerner,2 S Stoffel,2 T Melges,2 B Ainsworth3
ABSTRACT
An activity point system (APS) is presented that assists
healthcare providers and health professionals with a way
to prescribe exercise in a semiquantitative manner and to
motivate their patients to begin an exercise programme.
Activity points are specific to one’s body weight, body
mass index and activity intensity for 10-minute bouts of
activity performed. With a goal of accumulating 100–300
activity points per week, the APS provides a simple yet
quantitatively accurate way to prescribe exercise for
overweight and obese adults.
With overweight and obesity on the rise, new
treatment strategies to reduce overweight and
obesity must be improved further. Besides caloric
restriction, medication and surgery, regular exer-
cise as part of a behaviour modification programme
is highly effective, especially in patients with a
metabolic syndrome, ie, in people with hyperten-
sion, dyslipidaemia, impaired glucose metabolism
or diabetes mellitus type 2 and coronary heart
disease.1 2 In terms of cost to the healthcare
system, exercise is inexpensive and almost uni-
versally available.
Whereas many people get a lot of pleasure out of
exercise, sports and games, overweight and obese
patients quite often do not enjoy such activities.
Overweight and obese patients are frequently
affected with medical conditions and functional
limitations. Therefore, they need well-designed
exercise programmes and a careful introduction
on how to exercise.3 For exercise prescriptions to be
effective, physical activity programmes should be
designed and modified for the overweight and the
obese with the following points in mind:
c The aims of the exercise programme should be
discussed with the patient: metabolic fitness,
establishing an exercise habit, improving phy-
sical fitness and weight loss. Quite frequently
weight loss may not be a prime target in the
beginning of a programme. Instead, managing a
metabolic condition, such as diabetes, may be a
primary aim of the exercise programme.
c Medical problems, functional limitations and
disabilities.
c Physical activity history: activities a person has
performed in the past or when he/she was
young, activities he/she has always wanted to
learn and/or feels capable of performing.
c Actual physical activity status with respect to
the stages of readiness to begin an exercise
programme, according to the transtheoretical
model.4
c Barriers to regular exercise such as lack of time,
social influence, lack of energy, lack of will-
power, fear of injury, lack of skill, lack of
Short report
resources, weather conditions, travel, family
obligations or retirement years.3
Healthcare providers often lack formal training
in prescribing exercise to patients. To assist with
assigning and monitoring exercise, we have devel-
oped an activity point system (APS) for overweight
and obese adults that takes into consideration the
body mass index (BMI), body weight and exercise
intensity for a variety of lifestyle activities,
conditioning and sports activities.
THE ACTIVITY POINT SYSTEM
The APS for exercise prescription is a simple way to
prescribe and monitor physical activity pro-
grammes. The system assigns points based on a
patient’s BMI, body weight and the intensity of an
activity for 10-minute bouts. The APS should be
helpful by meeting the following requirements: to
motivate patients to become and remain physically
active; to allow quick exercise prescription and
programme modification; to allow quantification
of physical activities; and to relate the amount of
exercise performed and calories expended to
changes in body weight and clinical variables such
as plasma glucose and triglyceride levels, choles-
terol and hypertension, among others.
As shown in an example of the APS system
(table 1), the points assigned vary by BMI category
(class I, 25.0–29.9 kg/m2; class II, 30.0–39.9 kg/m2
and class III, >40.0 kg/m2), body weight ((90 kg;
.90 kg, etc) and the type of activity performed.
An example of the APS is provided in table 1. The
complete APS is presented as supplemental mate-
rial (see supplemental table 2 available online
only).
In an exercise programme for overweight and
obese patients, 100–300 activity points should be
collected weekly according to the individual’s
goals. On the basis of accepted recommendations
for the promotion and maintenance of health, the
optimum accumulation is between 200 and 300
activity points per week.1–3 5 6 As the total weekly
amount of energy expended and the amount
expended at higher intensities is also of prime
importance in the prevention and treatment of
health risks during exercise,2 7–10 it is beneficial to
accumulate more activity points and/or at higher
intensities if safely possible.
The activity points are based on the equations
published by Ainsworth and colleagues11 12 in the
Compendium of physical activities. The energy
expenditure for 60 daily and sports-related activ-
ities is calculated as follows:
Energy expenditure (kcal/minute) = factor 6
body weight (kg) 6 (number of minutes/60 min-
utes)
951
 Short report

Table 1 The APS

BMI I BMI II BMI III
25.0–29.9 30.0–39.9 >40
Activities of daily living (90 kg .90 kg (120 kg .120 kg (150 kg .150 kg

Bicycling (,10 mph, eg, to work) 5 6 7 8 9 10

Climbing stairs (up, down) 7 9 10 12 13 15
Desk work (eg, writing, reading, computer) 2 2 3 3 4 4
Gardening, lawn work 5 6 7 8 9 11
Housekeeping, light effort (eg, cooking, 2 3 4 5 6 7
washing, ironing)
Housekeeping, general (eg, sweeping, 4 5 6 7 8 9
vacuuming)
Shopping (walking, non-grocery) 2 3 4 5 5 6
Walking, strolling (,2 mph) 1 2 3 4 5 6
Walking (2.5 mph, eg, to work) 2 4 5 6 7 8
Activities of daily living in alphabetical order. The points indicated are based on 10 minutes’ duration of each activity, with the
exception of stair climbing, which refers to one minute. APS, activity point system.

where the ‘‘factor’’ denotes exercise intensity as metabolic
equivalent intensities and is a multiple of one metabolic
equivalent, ie, an oxygen intake of 3.5 ml/minute per kilogram.
This we did for three BMI classes including overweight, obese
classes I and II, and obese class III categories. As body weight
varies substantially within one BMI class, each class was
subdivided into two weight groups to account for the added
energy cost of moving more body weight.
To make things practical, the energy requirements were based
on 10 minutes’ duration of each activity, with the exception of
stair climbing, which was limited to one minute. As we felt that
overweight and obese people should not have to think in terms
of calories, which relate to dieting and therefore to an area
fraught with failure, and again to make the system easy to
handle, the calories were divided by 10 to yield ‘‘activity
points’’. Patients are thus encouraged to collect activity (and
‘‘health’’) points rather than estimate calories expended. If
desired, the calories expended in various activities can easily be
obtained by multiplying the activity points by 10 or they can be
calculated using the equation presented for computing energy
expenditure from the activity intensity, duration and the
individual’s body mass.
The APS can be personalised by inputting the corresponding
table into a computer for each patient and printing it out.
However, the points provided for the two weight groups within
each BMI class, eg, 90 kg or less and over 90 kg, are of sufficient

Figure 1 Example of a personal booklet that can be used to provide patients with an easy way to make a note of the daily activity points collected
with the activity point system. In the upper section, patients record the activity performed in the first column, an abbreviation for the activity (first letter
of the activity) recorded in the second column, and the number of points assigned according to their body mass index and body weight level for each
multiple of a 10-minute activity bout recorded in the remaining columns. On the right side of the form, patients record the week dates for the activity
period and comments regarding their activity during the week. In the bottom section, patients record the abbreviation for the activity performed in the
columns labelled (A for activity) and record the associated points earned for the duration of the activity in the columns labelled (P for points). The daily
total points are computed by summing all activity points completed each day and recording them in the column labelled daily total. The total weekly
activity points are computed by summing the daily activity points and recording them in the box labelled activity points, weekly total. The patient’s goal
is to accumulate between 100 and 300 activity points per week.

952 Br J Sports Med 2009;43:951–953. doi:10.1136/bjsm.2008.055657


accuracy to account for the energy expended by most patients.
As shown in fig 1, an additional table with weekdays, eg, in the
form of a personal booklet, can be used to provide patients with
an easy way to make a note of the daily activity points
collected. As a rule patients should only keep a book of activities
in addition to routine activities of daily living and light
intensity, such as self-care, casual walking, or less than
10 minutes’ duration such as walking to the parking lot. A
blank personal booklet is presented as supplemental material
(see supplementary fig 2 available online only).
In discussing the need for physical activity with overweight
and obese adults, healthcare providers can refer to the book,
Promoting physical activity: a guide for community action, published
by the US Department of Health and Human Services3 and to
the article, Self-efficacy, decision making and the stages of change: an
integrative model of physical exercise, by Marcus et al.4 These
resources are practical guides for identifying strategies to
increase physical activity.
CONCLUSION
The APS assists in simplifying and improving exercise prescrip-
tion, and patients quickly learn to use it correctly. But they
must be reminded, time and again, that collecting activity
points is not just a matter of calories but improves health and
fitness even in periods when body weight does not decrease.
Also, health professionals must provide exercise programmes
that are so well adapted and interesting that, eventually, their
patients start to enjoy physical activities, however simple or
limited these may be.
Competing interests: None.
Br J Sports Med 2009;43:951–953. doi:10.1136/bjsm.2008.055657
Short report
Provenance and peer review: Not commissioned; externally peer reviewed.
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