The Turtle or The Hare. The Diet or The Exercise: Which One Wins the Race?

April 23, 2019

By Cathy Leer, PT, MBA

I have a dear friend and book club buddy that always reads the end of the book first to see if she wants to read it. Unhappy ending….no go. Happy ending…I’m in. So why am I mentioning this? Because according to multiple studies and the CDC, diet tends to be more effective on promoting weight loss. There you have it! A happy ending for all you people who don’t like or want to do exercise. NOT SO FAST! The studies also show that diet alone may get you to lose weight, but in order to keep it off, exercise is a crucial component to long term weight loss.

As healthcare providers, physical therapists are often tasked with playing multiple roles or wearing multiple hats when dealing with our patients. It’s not enough to treat the diagnosis or injured part. We must treat the whole individual to be maximally effective. In the interest of time and because this article is about exercise and diet, let’s consider one small component of one example:

An Overweight Patient with Arthritis.

The physician orders are “evaluate and treat OA (osteoarthritis) of the R(ight) knee”. Some clinics or clinicians would wear the proverbial blinders and just address the issues with the knee. Treating holistically, we address some of the causative factors such as the obesity and the role it plays on the musculoskeletal system overall. Although we are not trained or licensed dieticians, nutritional counselors or nutritionists, we are trained on the effects of exercise and the role it plays on overall recovery. So, in this case, is exercise or diet best for losing weight (and keeping it off)?

One very basic and universally accepted rule of thumb is that in order to maintain weight, you must burn the same number of calories you take in. To lose weight you must burn more than you take in. This is a simple and easily understood concept.

Here is where the confusion can come in. If you diet alone, weight loss can be effective, but you lose it by shedding ~75% fat and 25% muscle. Dieting also decreases metabolism (the bodies way of turning food into energy). FAT is INERT. MUSCLE is ACTIVE. Being INERT, FAT doesn’t burn calories. Muscle, on the other hand, needs ENERGY to remain ACTIVE.  The result is that muscle burns more calories associated with the increase in metabolism associated with exercise. With diet alone the bottom line is a double whammy NEGATIVE. Metabolism decreases, AND you lose muscle. The result being a decrease in your ability to burn calories because of the combination of decreased metabolism and decreased muscle, which requires more energy to work.

A good example of how this might affect you, is from a study comparing individuals that performed different aerobic calorie burning activities.

  • Burning 400 cal/day 5 days per week lost 4.3% of their weight.
  • Burning 600 cal/day 5 days per week lost 5.7% of their weight.
  • Those that did not exercise gained .5%.

Overtime, this can add up, and may be one reason why studies show that up to 85% of those that experienced weight loss were unable to keep it off. That same study showed that those who were effective on keeping it off exercised regularly up to 1 hour per day.

Let’s talk about some of the kinds of exercise and the effects on weight loss. Aerobic exercise is generally a low-to-moderate exercise that you can do over a longer period of time, often referred to as “cardio”. Cardiovascular means that it primarily improves the heart and lungs, but it is not as effective on building muscle or changing body mass. Resistive or weight training on the other hand increases strength, tone, and muscle mass, as well as metabolism.

Remember, muscles are ACTIVE, so they require more energy to function. Calories are energy, so as a result, working your muscles burn more calories and contributes to weight loss. Think of calories in and calories out. It only makes sense that the more you burn, the better your chances of weight loss.

Here are a few links identifying some of the more common exercises and their associated calorie consumption from Harvard ( and the Mayo Clinic. (

Another important thing to consider, is that as we age, there is a natural decrease in muscle mass of 3-8% per decade of our life. As we lose muscle mass, our ability to lose, maintain, and prevent us from gaining weight becomes harder! That’s why exercising becomes more and more important in our later years. As I age it becomes more and more clear about the importance of finding something that you enjoy doing to improve the chances that you will continue to do it. I don’t think that there is anything worse than doing things that you don’t like to do. I personally am not a “gym rat”, but I do enjoy gardening as well as golfing, bicycling, and kayaking or paddle boarding.

Another VERY important concept is that WHAT you do is NOT as important as HOW you do it! It is imperative that you perform the activity correctly and safely, so you don’t injure yourself. Personally, I loathe the “no pain no game” mentality, or that “it has to hurt more before it gets better”. In fact, I believe that we were born with the capacity to feel pain for a reason. It is our bodies warning system to help protect us from danger or inflicting harm upon ourselves.

The bottom line is that to ignore pain is harmful. To ignore other warning signs such as shortness of breath is also harmful. Learn the warning signs and you will have greater control over your own destiny. But don’t forget…learning what they are isn’t enough, you must also learn the proper response to the message your body is sending.

Before wrapping up this article and getting to the true “ending”, I want to mention the many benefits of an appropriate exercise program.

Exercise can:

  • Prevent or reverse some diseases
  • Reverse high blood pressure (hypertension)
  • Decrease cholesterol
  • Decrease stress
  • Decrease anxiety and depression
  • Decrease the risk of colon and breast cancer
  • Decrease the risk of osteoporosis
  • Improve lean body mass (body composition)
  • Improve weight loss or long-term weight maintenance
  • Improve healing
  • Improve fitness
  • Increase metabolism and metabolic health

Contrary to these benefits, we know that obesity increases your chances of heart disease, diabetes, stroke, and some cancers as well as wear and tear on your muscles and joints. By default then, exercise also has the potential to prevent or minimize the risk of these same diseases. It’s also worth noting that the CDC determined that in 2010, over 1/3 of the American population was considered obese, or having a BMI (Body Mass Index) ( of > 30. (Do you know your body mass index?) With that kind of statistic, you might find yourself among this population. But you are not alone. There are many people struggling to overcome weight issues and many organizations and programs that are available to assist you in achieving your weight loss goals in a safe and effective manner.

If you are new to exercise; haven’t exercised in ages; are overweight or inactive; have arthritis or orthopedic issues, heart or lung disease, diabetes, or kidney disease; or are a smoker, you should obtain proper medical clearance prior to entering into an exercise program.

When starting a program remember to

  • walk before you run.
  • Break up your program into smaller bits and gradually increase as your tolerance and conditioning improves.
  • Add small bursts of increased intensity followed by lower intensity until you are better conditioned.

Go to a professional that is well trained in the field. You deserve to work with an expert! You only have one body!!

Finally…the winner is…, diet tends to be more effective on weight loss, but you need exercise to improve the chances of long-term weight loss. Therefore, the BEST method of promoting weight loss is a combination of diet AND exercise! (but you knew that already).

Whether you are a star athlete, a casual golfer, or have been away from activity for a while, our Connections Exercise Class is a perfect way to re-enter the world of exercise and activity in a safe and effective manner. Based off normal human movement patterns, it addresses real life function and combines exercises that improve mobility and stability to IMPROVE real life function

Post note: At FPTS, we have a number of practitioners and community partners that we know, like, and trust with the health and well being of our clients and their extended families and friends. Please visit our community partner page or reach out directly to us and we will provide you with some personal recommendations.

Also, please check out our Fitness Program page for some of the programs that we are offering on site and in the community.

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