Obesity, defined by the World Health Organization (WHO) as "abnormal or excessive fat
accumulation in the body that negatively affects health", has become an important public
health problem that affects the quality of life at individual and social levels. Obesity
is defined by using body mass index (BMI) (BMI ≥ 25 patients are classified as
overweight, BMI ≥30 as obese, BMI ≥40 as morbidly obese. Obese patients are classified
according to BMI as Class 1, BMI: 30-34.9 and Class 2, BMI: 35-39.9. Class 1 and 2
patients were included in the study. Patients will be included. Obesity can be
accompanied by comorbidities such as atherosclerotic vascular and cardiac pathologies,
hyperlipidemia, hypertension, coronary artery disease, diabetes mellitus and chronic
musculoskeletal disorders such as osteoarthritis, low back pain and fibromyalgia.
Therefore, obesity treatment should be managed multidisciplinary. The basic approach in
obesity treatment is diet. , exercise, medical treatment, treatment of comorbid
conditions and surgery.Aerobic exercise therapy, which is one of the conservative
approaches in the treatment of obesity, also has an important place in the treatment of
cardiovascular diseases associated with obesity. Atherosclerotic cardiovascular disease
(AKD) is one of the most important causes of morbidity and mortality worldwide. Negative
changes in functional capacity, quality of life and psychosocial situations are observed
due to disorders associated with this disease. Physical activity is among the modifiable
risk factors in atherosclerotic diseases. However, patients have a fear of movement
related to angina-like symptoms, with the thought that the symptoms may recur during
exercise. Lack of physical activity due to fear of movement leads to obesity, which in
turn leads to aggravation of atherosclerosis and an increase in the incidence of
cardiovascular events, which negatively affects individual and psychosocial capacity.
Anthropometry is the investigation of measurements of the human body in terms of bone
dimensions, muscle and fat tissue. Anthropometric measurements are measurements that
reveal the composition and body size / structure of the human body. Anthropometric
measurements gain importance when evaluating the nutritional status of people because
they show body fat storage and protein storage. Evaluation of growth and body
composition, that is, body fat and lean body tissue, can be determined by anthropometric
measurements. Anthropometric measurements help analyze the relationship between obesity
and diseases. Anthropometric measurements are important for evaluating the nutritional
status of a population or individual. Cardiopulmonary exercise test (CPET) is a
non-invasive procedure that evaluates the individual's capacity during dynamic exercise
and provides diagnostic and prognostic information. CPET is based on the investigation of
the respiratory system, cardiovascular system and cellular response to exercise performed
under controlled metabolic conditions. It allows holistic evaluation of the response to
exercise, including not only the pulmonary and cardiovascular systems but also the
musculoskeletal system. Fear of movement or kinesiophobia; It is defined as a state of
fear and avoidance of activity and physical movement resulting from the feeling of
sensitivity to painful injury and repeated injury. Kinesiophobia is assessed with the
Tampa Kinesiophobia Scale. This scale, consisting of 17 items, evaluates how afraid
patients are of moving their bodies. A high score indicates a high level of fear of
movement, while a low score indicates a negligible level of fear of movement. Each item
is scored on a 4-point Likert Scale; 1-4. The answers and their numerical values are as
follows: 1; Strongly disagree, 2; disagree, 3; agree and 4; I totally agree. The scores
of items 4, 8, 12 and 16 should be reversed when calculating the total score. The total
score obtained by adding different items may vary between 17 and 68. Previous studies
have shown that this scale is generally applied to patients with low back pain, knee
osteoarthritis, lymphedema and osteoporosis. In the literature, there are limited age
group and uncontrolled studies in patients with cardiovascular disease. However, to the
best of this knowledge, this study will be one of the limited number of blind,
prospective, randomized controlled studies in the literature that evaluate fear of
movement in obese patients with atherosclerotic cardiovascular disease who receive
aerobic exercise therapy. The aim of this study is to investigate the effects of an
aerobic exercise program on anthropometric measurements, kinesiophobia, psychosocial
status, physical activity level and quality of life in obese individuals with
atherosclerotic cardiovascular disease. This hypothesis in this study is that an aerobic
exercise program will cause significant changes in anthropometric measures, kinesiophobia
and quality of life in obese patients with atherosclerotic heart disease. In this study,
it is expected that a regular, supervised aerobic exercise program will create a more
effective response in terms of physical, psychosocial and patient compliance in the
individual compared to a home exercise program in obese individuals who often have a
sedentary lifestyle, and therefore will provide a change in anthropometric measurements.
Patients who are admitted to Kayseri City Hospital Physical Medicine and Rehabilitation
Clinic Cardiopulmonary Rehabilitation Unit, between the ages of 18-65, with a BMI of
30-40, with class 1 and 2 obese atherosclerotic cardiovascular pathology, and with
American Heart Association stage B and New York Heart Association class 1 will be
included in this study. Patients participating in the study will be randomized into 2
groups: moderate-intensity continuous exercise group (Group 1) and home exercise group
(Group 2). The change in the average Tampa Scale Kinesiophobia (TSK) score of each group
over time will be evaluated within the 0th, 8th and 20th weeks. Additionally, the change
in the average TSK scores between the two groups over time (0th, 8th and 20th weeks) will
be compared. In this hypothesis; A decrease in TSK score is expected over time with the
exercise program. The minimum sample size required to find a significant difference
between both groups was determined by Jiménez et al. It was calculated in the G*Power
3.1.9.4 program, using the study as a reference. According to these criteria; While the
power of the test (1-β) is 0.80, the amount of type-1 error (α) is 0.05, and the
alternative hypothesis (H1) is one-sided, the minimum sample size required to find a
significant difference between the groups is a total of 28 patients, 14 patients in each
group. calculated as a patient. The dropout rate was estimated to be 10%. Therefore, a
total of 32 patients will be included in the study, 16 patients in both groups.
