2025 Theses Doctoral

The Role of Personalized Exercise Prescriptions on Body Composition and Health Outcomes in Adults Living with Obesity

Kuper, Jeremy

As of August 2023, 40.3% of U.S. adults were classified as obese, and this prevalence is projected to rise to 48.9% by 2030. To combat obesity and its associated comorbidities, individuals utilize various evidence-based treatment options. These treatment options include bariatric surgery, pharmacotherapy, behavioral interventions, nutrition, and physical activity. Although often undervalued, physical activity plays a critical role in obesity care.

This dissertation aimed to assess the effect of personalized exercise programs on obesity-related health outcomes. To achieve this, this dissertation consists of three manuscripts. Chapter II presents a narrative review of randomized controlled trials (RCTs) from 2015 to 2025, examining the effects of structured exercise programs (>4 weeks) on cardiovascular and metabolic health parameters, glucagon-like peptide-1 (GLP-1) agonist interventions, bariatric surgery outcomes, mental health, and quality of life in adults with obesity. Findings from Chapter II highlight the broad benefits of structured exercise programs on cardiovascular structure and function, lipid profiles and inflammation, glycemic control and insulin sensitivity, muscle strength, function, and mitochondrial health, GLP-1 agonist therapy, and mental well-being and quality of life.

Chapter III reports on a randomized pilot study conducted at Teachers College, Columbia University. This pilot study evaluated the effects of combining bioelectrical impedance analysis (BIA) assessment results with exercise counseling using guidelines from the American College of Sports Medicine (ACSM) and American Heart Association (AHA). This pilot study examines the effects of two different body composition feedback approaches on body composition in overweight and obese individuals over eight weeks. The Control group received standard feedback limited to weight and BMI, while the ACSM and AHA groups received expanded feedback that included weight, BMI, skeletal muscle mass (SMM), fat mass (FM), fat mass percentage (FM%), and visceral adipose tissue (VAT). The pilot study observed non-significant improvements in body composition metrics following exercise counseling and BIA assessments across intervention groups in 8 weeks. These results helped inform the design of the more robust analysis in Chapter IV.

Chapter IV presents a retrospective analysis of clinical data from a large state-wide physical therapy and wellness practice in New Jersey. The retrospective chart review examined the effects of an exercise physiology weight management program (5.7 ± 3.9 months) on body composition parameters in adult patients of varying BMI classifications. Participants were separated into three BMI categories (normal weight, overweight, and obese) to examine the differential effectiveness of the program across the adult weight spectrum. This approach may support the generalizability and clinical relevance of findings while directing future research. Patients in the program received the following baseline exercise physiology services: medical body composition analysis (mBCA), resting metabolic rate (RMR) testing, pulmonary function tests (PFT), and maximal oxygen uptake (VO2Max) testing.

These assessments guided individual’s personalized exercise prescription, lifestyle counseling, and weekly exercise sessions. Dependent variables of the study, including weight, body mass index (BMI), skeletal muscle mass (SMM), fat mass percentage (FM%), fat mass (FM) and visceral adipose tissue (VAT), were assessed at each patient’s initial and final appointment of their program. At baseline, significant differences in anthropometric and body composition measures were observed across weight groups (normal weight, overweight, obese). Participants with obesity had significantly higher body weight, BMI, FM, FM%, VAT, and skeletal muscle mass compared to those in the overweight and normal-weight group (p < 0.05). Following the programs, all groups demonstrated significant within-group reductions in weight, BM, FM, FM%, and VAT (p < 0.05), indicating improvements in body composition improvements overtime. Time x BMI category interaction effects revealed that changes in weight, BMI, FM, and VAT varied significantly by group, with the obese group showing the greatest absolute reduction (p <0.01). In contrast, changes in FM% did not differ significantly across BMI groups. SMM increased modestly across the full sample (p =0.20), but time x group interaction effects were not significant, indicating similar gains across BMI classifications. These findings suggest that personalized exercise physiology interventions may produce beneficial body composition outcomes across the adult weight spectrum.

In conclusion, findings from this dissertation suggest that participating in personalized, structured physical activity programs may support improvements in obesity-related health outcomes beyond traditional weight loss measures. Evidence from a narrative review, pilot study, and retrospective chart review indicate that such interventions may positively influence cardiovascular and metabolic health, as well as body composition metrics including weight, BMI, FM, FM%, and VAT. These results may support the role of physical activity as a central component of comprehensive obesity care and challenge the traditional view of physical activity as only a weight loss loss. Instead, physical activity may be better understood as a therapeutic intervention that contributes to improvements in fat distribution, muscle preservation, metabolic function, and cardiorespiratory fitness. Collectively, the findings suggest that integrating exercise physiology into routine obesity care may enhance both short-term and long-term health outcomes such as body composition, cardiorespiratory fitness, physical function, and all-cause mortality.