Comparison of Protein- or Amino Acid-Based Supplements in the Rehabilitation of Men with Severe Obesity: A Randomized Controlled Pilot Study.

BACKGROUND: Weight loss is associated with a reduction in all body compartments, including muscle mass (MM), and this effect produces a decrease in function and muscle strength. Our objective was to assess the impact of protein or amino acid supplements on MM loss in middle-aged men (age < 65 years) with severe obesity (BMI > 35 kg/m2) during weight loss. MATERIALS AND METHODS: We conducted a single-site randomized controlled trial (Clinicaltrials.gov NCT05143398) with 40 in-patient male subjects with severe obesity. Participants underwent an intervention program consisting of a low-calorie balanced diet and structured physical activity. They were randomly assigned to 4-week treatment groups: (1) control (CTR, N = 10), (2) protein (P, N = 10), (3) branched-chain amino acid (BCAA, N = 10), and (4) essential amino acid mixture with tricarboxylic acid cycle intermediates (PD-E07, N = 10) supplementation. RESULTS: Following 4 weeks of intervention, all groups showed similar reductions in body weight compared to baseline. When examining the delta values, a notable increase in muscle mass (MM) was observed in the PD-E07 intervention group [MM (kg): 2.84 ± 3.57; MM (%): 3.63 ± 3.14], in contrast to the CTR group [MM (kg): -2.46 ± 3.04; MM (%): -0.47 ± 2.28], with a statistical significance of p = 0.045 and p = 0.023, respectively. However, the MM values for the P group [MM (kg): -2.75 ± 5.98, p = 0.734; MM (%): -0.44 ± 4.02, p = 0.990] and the BCAA group [MM (kg): -1 ± 3.3, p = 0.734; MM (%): 0.34 ± 2.85, p = 0.956] did not exhibit a statistically significant difference when compared to the CTR group. CONCLUSIONS: Amino acid-based supplements may effectively mitigate the loss of MM typically observed during weight reduction. Further validation through large-scale studies is necessary.

Is Whole-Body Cryostimulation an Effective Add-On Treatment in Individuals with Fibromyalgia and Obesity? A Randomized Controlled Clinical Trial.

Pain severity, depression, and sleep disturbances are key targets for FM rehabilitation. Recent evidence suggests that whole-body cryostimulation (WBC) might be an effective add-on treatment in the management of FM. The purpose of this study was to evaluate the effects of an add-on WBC intervention to a multidisciplinary rehabilitation program on pain intensity, depressive symptoms, disease impact, sleep quality, and performance-based physical functioning in a sample of FM patients with obesity. We performed a randomized controlled trial with 43 patients with FM and obesity undergoing a multidisciplinary rehabilitation program with and without the addition of ten 2-min WBC sessions at -110 °C over two weeks. According to our results, the implementation of ten sessions of WBC over two weeks produced additional benefits. Indeed, both groups reported positive changes after the rehabilitation; however, the group that underwent WBC intervention had greater improvements in the severity of pain, depressive symptoms, disease impact, and quality of sleep. On the contrary, with respect to performance-based physical functioning, we found no significant between-group differences. Our findings suggest that WBC could be a promising add-on treatment to improve key aspects of FM, such as pain, depressive symptoms, disease impact and poor sleep quality.

Whole-body cryostimulation in obesity. A scoping review.

Currently available treatments for the management of obesity struggle to provide clinically significant weight loss and reduction of the chronic low-grade inflammatory state in order to reduce obesity-related complications. This scoping review aims to provide an up-to-date picture of the therapeutic effects of Whole-Body Cryostimulation (WBC) in patients with obesity and evidence-based indications for its complementary use in the treatment of obesity. We searched the literature until the end of August 2021, retrieving 8 eligible studies out of 856, all evaluated for their methodological quality using the Downs and Black checklist. Overall, the limited data presented in this review article seem to support the efficacy of WBC as an adjuvant treatment in obesity. The cryogenic stimulus has important anti-inflammatory/antioxidant effects and its effectiveness is directly related to the individual percentage of fat mass and initial fitness capacity, mimicking an exercise-induced effect. Based on the limited results gathered, WBC emerges as a promising adjuvant therapy to reduce systemic inflammation, oxidative stress, abdominal obesity, and body mass. However, the data presented in this review article fail to reach definitive conclusions with regards to the efficacy of WBC in the treatment of obesity. Application of WBC protocols yields the potential to widen the therapeutic armor for the treatment of obesity and obesity-related disorders but larger, high-quality studies are still needed.

A Comparative Analysis of Shoes Designed for Subjects with Obesity Using a Single Inertial Sensor: Preliminary Results.

Walking remains a highly recommended form of exercise for the management of obesity. Thus, comfortable and adequate shoes represent, together with the prescription of a safe adapted physical activity, an important means to achieve the recommended physical activity target volume. However, the literature on shoes specific for obese individuals is inadequate. The aim of the present study was to compare the performance of shoes specifically designed for subjects with obesity with everyday sneakers during instrumented 6-min walking test and outdoor 30-min ambulation in a group of subjects with obesity using a single wearable device. Twenty-three obese individuals (mean age 58.96 years) were recruited and classified into two groups: deconditioned (n = 13) and non-deconditioned patients (n = 10). Each participant was evaluated with his/her daily sneakers and the day after with shoes specifically designed for people with obesity by means of a questionnaire related to the comfort related to each model of shoes and instrumentally during the i6MWT and an outdoor walking test. The results showed that the specifically designed shoes displayed the higher score as for comfort, in particular in the deconditioned group. During the i6MWT, the distance walked, and step length significantly increased in the deconditioned group when specifically designed shoes were worn; no significant changes were observed in the non-deconditioned individuals. The deconditioned group displayed longer step length during the outdoor 30-min ambulation test. In the non-deconditioned group, the use of specific shoes correlated to better performance in terms of gait speed and cadence. These data, although preliminary, seem to support the hypothesis that shoes specifically conceived and designed for counteracting some of the known functional limitations in subjects with obesity allow for a smoother, more stable and possibly less fatiguing gait schema over time.

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients.

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

Effect of Obesity on Knee and Ankle Biomechanics during Walking.

The purpose of this retrospective study was to quantify the three-dimensional knee and ankle joint kinematics and kinetics during walking in young participants with different degrees of obesity and to identify the associated effects by stratifying the obese participants according to their BMI. Thirty-two young obese individuals (mean age 30.32 years) and 16 normal-weight age-matched individuals were tested using 3D gait analysis. Analysis of kinematic and kinetic data revealed significant differences in mechanics at knee and ankle joints in all the evaluated planes of movement. Compared to the healthy-weight participants, obese adults demonstrated less knee flexion, greater knee ab-adduction angle during the entire gait cycle and abnormalities at the knee flex-extension moment. At the ankle joint, reduced range of motion was observed together with a lower peak of ankle plantarflexor moment and power during terminal stance. These results provide insight into a potential pathway by which obesity predisposes a healthy adult for increased risk of osteoarthritis.

Effects of a Randomized Home-Based Quality of Movement Protocol on Function, Posture and Strength in Outpatients with Obesity.

The aim of this study was to determine the effects of two different home-based training interventions on functional parameters and body composition in obese patients. Sixty-four obese patients were recruited at the IRCCS Istituto Auxologico Italiano and randomly assigned into a movement quality group (MQ) and a conventional training group (CT). In the MQ, the training protocol combined various stimuli based on whole-body movement patterns, mobility, motor control and diaphragmatic breathing. The CT included traditional bodyweight resistance-training exercises. All patients were tested for movement efficiency (Functional Movement Screen, FMS), postural control (Modified Balance Error Scoring System, M-BESS), breathing pattern (Total Faulty Breathing Scale, TFBS), muscular strength (Handgrip Strength Test, HST and Five Repetition Sit to Stand, FRSTS) and body composition (Waist Circumference, WC, Body Mass Index, BMI, Body fat mass percentage, Fat Mass) before and after a 6-week period of training. Significant interactions and main effects of time (p < 0.0001) were found in MQ compared to CT in the FMS, M-BESS and TFBS parameters, while muscular strength (HST, FRSTS) and body composition parameters improved similarly in both groups with a main effect of time (p < 0.05). These findings suggest that a 6-week movement quality training is effective in ameliorating postural control and movement efficiency with similar improvements in muscular strength and body composition compared with a mere traditional home-based training. Fitness coaches and practitioners might consider the MQ intervention as a valuable alternative to conventional training when treating obesity.

Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program?

BACKGROUND: The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated. SUMMARY: The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.