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European Journal of Physical and Rehabilitation Medicine 2020 August;56(4):496-507

DOI: 10.23736/S1973-9087.20.06232-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

ISPRM/ESPRM guidelines on Physical and Rehabilitation Medicine professional practice for adults with obesity and related comorbidities

Emanuele M. GIUSTI 1, 2 , Chiara A. SPATOLA 1, 2, Amelia BRUNANI 3, Dinesh KUMBHARE 4, Aydan ORAL 5, Elena ILIEVA 6, Carlotte KIEKENS 7, 8, Giada PIETRABISSA 1, 2, Gian Mauro MANZONI 2, 9, Marta IMAMURA 10, Gianluca CASTELNUOVO 1, 2, Paolo CAPODAGLIO 3

1 Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy; 2 Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy; 3 Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy; 4 Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada; 5 Department of Physical and Rehabilitation Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 6 Department of Physical and Rehabilitation Medicine, Sv. Georgi University Hospital, Plovdiv, Bulgaria; 7 Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven Belgium; 8 Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy; 9 Faculty of Psychology, eCampus University, Novedrate, Como, Italy; 10 Institute of Physical and Rehabilitation Medicine, University of São Paulo School of Medicine, São Paulo, Brazil



BACKGROUND: The World Health Organization (WHO) has declared obesity as the largest global chronic health problem in adults. In the last years, attention has been drawn to rehabilitative interventions for patients with obesity.
AIM: The aim of this manuscript is to provide Physical and Rehabilitation Medicine (PRM) physicians with evidence-based recommendations for the rehabilitation of patients with overweight or obesity and related comorbidities.
DESIGN: Evidence-based guidelines.
POPULATION: Adults with overweight or obesity.
METHODS: Guidelines were based on GRADE and WHO recommendations. A comprehensive search of the available evidence about rehabilitation treatments for obesity was performed, and 17 separate systematic literature reviews were conducted. For each outcome, estimates of the effects of rehabilitation treatments were computed and employed along with an assessment of quality of evidence, desirable and undesirable effects, values and preferences to formulate the recommendations. Recommendations were reviewed by a consensus expert panel using a modified Delphi process.
RESULTS: We strongly recommend providing comprehensive multiprofessional and multidisciplinary interventions including exercise, diet and behavioral or cognitive-behavioral therapy. The nutritional component of these treatments should include diets with either a high-protein or a low-fat content. It is strongly recommended to prescribe frequent moderate aerobic exercise. We strongly recommend providing cognitive-behavioral interventions as the behavioral component of rehabilitation programs.
CONCLUSIONS: PRM physicians should lead multidisciplinary teams providing comprehensive and individualized rehabilitation programs for patients with overweight or obesity. These guidelines were endorsed by the International Society of Physical and Rehabilitation Medicine (ISPRM) and by the European Society of Physical and Rehabilitation Medicine (ESPRM).


KEY WORDS: Obesity; Overweight; Rehabilitation; Physical and Rehabilitation Medicine; Guidelines

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