The irony of fitness promotion is that it rarely shows images of overweight people at the gym or using a set of dumbbells – even though they're the group that often needs the most encouragement.
"Ads for gyms have photos of muscled men and lean women in crop tops – yet they're the people already working out," says Melbourne exercise physiologist Jennifer Smallridge. "We need to create an acceptance of overweight people exercising – and gyms could benefit by using more images of bigger people."
So could bigger people themselves, adds Abby Byrne, an exercise physiologist based in Ballarat.
"We need to send messages that anyone can get fitter with exercise. "
Still, there are small steps forward. The fat yoga movement is spreading the word that yoga works for people of any size and, for all it critics, Channel 10's Biggest Loser program has helped normalise the idea of bigger people working out.
"I don't like Biggest Loser's training style – but I do think it's created empathy and a greater understanding of what it's like to be very overweight," says Ray Kelly, another exercise physiologist who, like Smallridge and Byrne, works with people carrying too many extra kilos. "For those who are overweight, it's very empowering to see people like them getting fitter."
Around 80 per cent of clients in Kelly's Newcastle practice have been referred by a GP for an exercise program to treat chronic problems like prediabetes, type 2 diabetes, high blood pressure and joint pain often related to their size.
But one obstacle to helping overweight, inactive people get fitter is the perception that they have to blast their bodies with fast, high-intensity exercise, he says.
"People see research in the media about how high-intensity interval training can burn fat and they feel they have to flog themselves to get results and it puts them off – or they give it a try and get an injury."
Instead, helping clients like these can mean starting small – perhaps with as little as ten minutes a day, sometimes divided into five two-minute sessions for the very inactive. It might not seem like much but the key to getting people fitter is helping them build a regular habit. Kelly says.
"If you can get them walking for 30 minutes a day it can make a huge difference to their health."
Along with regular walks, good ways to exercise for anyone carrying a lot of weight include stationary bikes and weights machines at the gym. An exercise bike is better than running because it can boost cardiovascular fitness without putting a load on the joints, says Abby Byrne, while weights machines can help people exercise and build strength in large muscle groups which helps with weight loss and blood sugar control.
It's not hard for weight and inactivity to creep up – often triggered by life changes like having a baby or retirement, says Byrne. For mothers of young babies, the energy deficit that comes from lack of sleep and the demands of parenthood can make it harder to fit in exercise, while retirement can bring more sitting. Injuries, illness, traumatic events or life changes like a new job can also set people up for inactivity.
"It becomes a cycle. The less active you are, the more lethargic you become and gradually you become weaker and it gets harder to be active," says Smallridge, who works with clients having bariatric surgery – including increasing numbers of people in their 20s and 30s.
"Some people also have bad memories of exercise that's put them off physical activity – often stemming from PE classes or sport in school when they were never picked for a team and felt they weren't good enough or were too big."
Smallridge often develops exercise programs for people to follow at home, including people who feel self-conscious about going for a walk outdoors.
"They feel that everyone is looking at them, so I get people to build confidence at home. They may not burn the same energy as they would in a gym but it's more about getting them to have ease of movement and to see how good movement feels," she says, adding that it doesn't take long for the body to feel the benefit.
"It responds instantly to a bout of exercise – excess blood sugar is taken up and used by the muscles and there's a measurable drop in blood pressure after physical activity which lasts for several hours to follow – and with a regular exercise habit these can soon turn into long-term changes.
"I also remind people that underneath the layers of weight they have muscles that need movement to build their strength – and that having that strength will make it much easier to move."
Overweight and need help to get fitter? You may be eligible for a Medicare rebate for up to five sessions with an accredited exercise physiologist in a year if you have a referral from your GP.