Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults.

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3-4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3-4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

Effects of an acute bout of exercise on circulating extracellular vesicles: tissue-, sex-, and BMI-related differences.

BACKGROUND: Exercise is recognized to evoke multisystemic adaptations that, particularly in obese subjects, reduce body weight, improve glucometabolic control, counteract sarcopenia, and lower the risk of cardiometabolic diseases. Understanding the molecular and cellular mechanisms of exercise-induced benefits is of great interest due to the therapeutic implications against obesity. OBJECTIVES AND METHODS: The aim of the present study was to evaluate time-related changes in size distribution and cell origin of extracellular vesicles (EVs) in obese and normal-weight subjects who underwent a moderate-intensity exercise on a treadmill (at 60% of their VO2max). Blood samples were drawn before, immediately at the end of the exercise and during the postexercise recovery period (3 and 24 h). Circulating EVs were analyzed by a nanoparticle tracking analysis and flow cytometry after labeling with the following cell-specific markers: CD14 (monocyte/macrophage), CD61 (platelet), CD62E (activated endothelium), CD105 (total endothelium), SCGA (skeletal muscle), and FABP (adipose tissue). RESULTS: In all subjects, acute exercise reduced the release of total (i.e., 30-700 nm) EVs in circulation, predominantly EVs in the microvesicle size range (i.e., 130-700 nm EVs). The postexercise release of microvesicles was higher in normal-weight than obese subjects; after exercise, circulating levels of exosomes (i.e., 30-130 nm EVs) and microvesicles were, respectively, lower and higher in females than males. In all experimental subgroups (males vs. females and obese vs. normal-weight subjects), acute exercise reduced and increased, respectively, CD61 + and SCGA + EVs, being the effect on CD61 + EVs prolonged up to 24 h after the end of the test with subjects in resting conditions. Total EVs, exosomes, and CD61 + EVs were associated with HOMA-IR. CONCLUSIONS: Though preliminary, the results of the present study show that a single bout of acute exercise modulates the release of EVs in circulation, which are tissue-, sex-, and BMI specific, suggesting that the exercise-related benefits might depend upon a complex interaction of tissue, endocrine, and metabolic factors.

Obesity-associated poor muscle quality: prevalence and association with age, sex, and body mass index.

BACKGROUND: Muscle quality (i.e., the expression of muscle function per unit of muscle mass) has been proposed as a clinically-relevant measure to detect individuals at risk of functional incapacity. Individuals with obesity might be at an increased risk of having poor muscle quality. Thus, we aimed to analyze the prevalence of poor muscle quality in obese individuals, to determine associated variables, and to provide normative values for this population. METHODS: 203 individuals with obesity (103 women, age: 18-75 years, body mass index (BMI): 35-64 kg·m- 2) participated in this cross-sectional study. Their muscle strength (handgrip dynamometry), muscle power (sit-to-stand test) and muscle mass (bioelectrical impedance analysis) were measured, and muscle quality (strength/power to muscle mass ratio) was compared with reference values obtained in young healthy individuals. Muscle quality was individually categorized as normal, low or poor based on specific muscle strength and power (i.e., strength and power per unit of muscle mass, respectively). Sex and age-specific normative values of specific muscle strength and power were computed for the whole cohort. RESULTS: Age and being a woman were inversely associated with specific muscle strength, with age being also inversely associated with specific muscle power. A small proportion of participants (6%) presented with an impaired (i.e., low/poor) specific muscle power while most of them (96%) had impaired specific muscle strength. Eventually, 84% of the participants were deemed to have poor muscle quality. Being a woman (odds ratio [OR]: 18.09, 95% confidence intervals [CI]: 4.07-80.38), age (OR: 1.06, 95%CI: 1.03-1.10) and BMI (OR: 1.22, 95%CI: 1.07-1.38) were independently associated with a higher risk of poor muscle quality in adjusted analyses. CONCLUSIONS: These findings show a high prevalence of poor muscle quality among individuals with obesity, with age, sex and BMI being independent predictors.

Metabolic and muscular factors limiting aerobic exercise in obese subjects.

PURPOSE: The aim of the present study was to understand the role of central (cardiovascular O2 delivery) and peripheral factors (muscle level) in limiting the maximal aerobic performance in obese (OB) subjects. METHODS: Fifteen OB (mean age ± SD 25 ± 7 years; BMI 43 ± 7 kg/m2) and 13 lean sedentary subjects (CTRL, age 27 ± 7 years; BMI 22 ± 3 kg/m2) participated in this study. Oxygen uptake (VO2), hearth rate (HR) and cardiac output (CO) were measured during cycle ergometer (CE) and knee extension (KE) incremental tests. Maximal voluntary contractions (MVCs) of knee extensor muscles were performed before and immediately after the two tests. RESULTS: VO2peak, HR peak and CO peak were significantly higher in CE than KE (+ 126%, + 33% and + 46%, respectively, p < 0.001), both in OB and CTRL subjects, without differences between the two subgroups. Maximal work rate was lower in OB than CTRL (191 ± 38 vs 226 ± 39 W, p < 0.05) in CE, while it was similar between the two subgroups in KE. Although CE and KE determined a reduction of MVC in both subgroups, MVC resulted less decreased after CE than KE exercises (- 14 vs - 32%, p < 0.001) in OB, while MVC decrements were similar after the two exercises in CTRL (- 26% vs - 30%, p > 0.05, for CE and KE, respectively). CONCLUSIONS: The lower muscle fatigue observed in OB after CE compared to KE test suggests that central factors could be the most important limiting factor during cycling in OB.

Symmetry of Gait in Underweight, Normal and Overweight Children and Adolescents.

Abnormal excess or lack of body mass can influence gait patterns, but in some cases such differences are subtle and not easy to detect, even with quantitative techniques for movement analysis. In these situations, the study of trunk accelerations may represent an effective way to detecting gait anomalies in terms of symmetry through the calculation of Harmonic Ratio (HR), a parameter obtained by processing trunk accelerations in the frequency domain. In the present study we used this technique to assess the existence of differences in HR during gait in a cohort of 75 healthy children and early adolescents (aged 7-14 years) stratified into 3 equally-sized age and gender-matched groups (Underweight: UW; Normal Weight: NW; Overweight: OW). The accelerometric signal, acquired using a single wearable inertial sensor, was processed to calculate stride length, speed, cadence and HR in antero-posterior, vertical and medio-lateral directions. No differences in spatio-temporal parameters were found among groups, while the HR in the medio-lateral direction was found significantly lower in UW children, while OW exhibited the highest values. On the basis of the results obtained, HR appears capable of discriminating gait symmetry in children with different body mass even when conventional gait parameters are unchanged.

Assessment of fat-free mass from bioelectrical impedance analysis in men and women with Prader-Willi syndrome: cross-sectional study.

We have recently shown that population-specific formulae are required to estimate fat-free mass (FFM) from bioelectrical impedance analysis (BIA) in obese women with Prader-Willi syndrome (PWS) matched by age and percent fat mass (FM) to non-PWS women. The present cross-sectional study was aimed at developing generalised BIA equations that could be used in PWS subjects independently of sex and FM. We used dual-energy X-ray absorptiometry to measure FFM and BIA to measure whole-body impedance at 50 kHz (Z50) in 34 women and 21 men with PWS. The impedance index, that is, height (cm)2/Z50 (Ω), explained 77% (BCa-bootstrapped 95% CI 65 to 85%) of the variance of FFM with a root mean squared error of the estimate of 3.7 kg (BCa-bootstrapped 95% CI 3.2 to 4.5 kg). BIA can be used to estimate FFM in obese and non-obese PWS men and women by means of population-specific equations.

Ergogenic effects of beetroot juice supplementation during severe-intensity exercise in obese adolescents.

Previous studies showed a higher O2 cost of exercise, and therefore, a reduced exercise tolerance in patients with obesity during constant work rate (CWR) exercise compared with healthy subjects. Among the ergogenic effects of dietary nitrate ([Formula: see text]) supplementation in sedentary healthy subjects, a reduced O2 cost and enhanced exercise tolerance have often been demonstrated. The aim of this study was to evaluate the effects of beetroot juice (BR) supplementation, rich in [Formula: see text], on physiological variables associated with exercise tolerance in adolescents with obesity. In a double-blind, randomized crossover study, 10 adolescents with obesity (8 girls, 2 boys; age = 16 ± 1 yr; body mass index = 35.2 ± 5.0 kg/m2) were tested after 6 days of supplementation with BR (5 mmol [Formula: see text] per day) or placebo (PLA). Following each supplementation period, patients carried out two repetitions of 6-min moderate-intensity CWR exercise and one severe-intensity CWR exercise until exhaustion. Plasma [Formula: see text] concentration was significantly higher in BR versus PLA (108 ± 37 vs. 15 ± 5 µM, P < 0.0001). The O2 cost of moderate-intensity exercise was not different in BR versus PLA (13.3 ± 1.7 vs. 12.9 ± 1.1 ml·min-1·W-1, P = 0.517). During severe-intensity exercise, signs of a reduced amplitude of the O2 uptake slow component were observed in BR, in association with a significantly longer time to exhaustion (561 ± 198 s in BR vs. 457 ± 101 s in PLA, P = 0.0143). In obese adolescents, short-term dietary [Formula: see text] supplementation is effective in improving exercise tolerance during severe-intensity exercise. This may prove to be useful in counteracting early fatigue and reduced physical activity in this at-risk population.

Respiratory muscle endurance training reduces the O2 cost of cycling and perceived exertion in obese adolescents.

In obesity, the increased O2 cost of breathing negatively affects the O2 cost of exercise and exercise tolerance. The purpose of the study was to determine whether, in obese adolescents, the addition of respiratory muscle endurance training (RMET) (isocapnic hyperpnea) to a standard body mass reduction program decreases the O2 cost of exercise and perceived exertion. Nine male obese adolescents [16.0 ± 1.4 yr (x ± SD), body mass 114.4 ± 22.3 kg] underwent 3 wk of RMET (5 days/week) in addition to a standard body mass reduction program. Eight age- and sex-matched obese adolescents underwent only the standard program (CTRL). Before and after interventions, patients performed on a cycle ergometer: incremental exercise; 12-min exercises at a constant work rate (CWR) of 65% and 120% at the gas exchange threshold (GET) determined before the intervention. Breath-by-breath pulmonary ventilation (V̇e) and O2 uptake (V̇o2), heart rate (HR), and ratings of perceived exertion for dyspnea/respiratory discomfort (RPER) and leg effort (RPEL) were determined. Body mass decreased (by ~3.0 kg) after both RMET (P = 0.003) and CTRL (P = 0.002). Peak V̇o2 was not affected by both interventions. Peak work rate was slightly, but significantly (P = 0.04), greater after RMET but not after CTRL. During CWR < GET, no changes were observed after both interventions. During CWR > GET, the O2 cost of cycling at the end of exercise (P = 0.02), the slope of V̇o2 vs. time (3-12 min) (P = 0.01), RPER (P = 0.01), and RPEL (P = 0.01) decreased following RMET, but not following CTRL. HR decreased after both RMET (P = 0.02) and CTRL (P = 0.03), whereas V̇e did not change. In obese adolescents RMET, superimposed on a standard body mass reduction program, lowered the O2 cost of cycling and perceived exertion during constant heavy-intensity exercise.

Acute respiratory muscle unloading by normoxic helium-O2 breathing reduces the O2 cost of cycling and perceived exertion in obese adolescents.

PURPOSE: In obesity, an increased work of breathing contributes to a higher O2 cost of exercise and negatively affects exercise tolerance. The purpose of the study was to determine whether, in obese adolescents, acute respiratory muscle unloading via normoxic helium-O2 breathing reduces the O2 cost of cycling and perceived exertion. METHODS: Nine males [age 16.8 ± 1.6 (x ± SD) years, body mass 109.9 ± 15.0 kg] performed on a cycle ergometer, breathing room air (AIR) or a 21 % O2-79 % helium mixture (He-O2): an incremental exercise, for determination of [Formula: see text]O2 peak and gas exchange threshold (GET); 12 min constant work rate (CWR) exercises at 70 % of GET (GET) determined in AIR. RESULTS: [Formula: see text]O2 peak was not different in the two conditions. From the 3rd to the 12th minute of exercise (both during CWR < GET and CWR > GET), [Formula: see text]O2 was lower in He-O2 vs. AIR (end-exercise values: 1.40 ± 0.14 vs. 1.57 ± 0.22 L min(-1) GET). During CWR > GET in AIR, [Formula: see text]O2 linearly increased from the 3rd to the 12th minute of exercise, whereas no substantial increase was observed in He-O2. The O2 cost of cycling was ~10 % (GET) lower in He-O2 vs. AIR. Heart rate and ratings of perceived exertion for dyspnea/respiratory discomfort and leg effort were lower in He-O2. CONCLUSIONS: In obese adolescents, acute respiratory muscle unloading via He-O2 breathing lowered the O2 cost of cycling and perceived exertion during submaximal moderate- and heavy-intensity exercise.

Assessment of fat-free mass from bioelectrical impedance analysis in obese women with Prader-Willi syndrome.

BACKGROUND: Fat-free mass (FFM) is lower in obese subjects with Prader-Willi syndrome (PWS) than in obese subjects without PWS. FFM prediction equations developed in non-PWS subjects may, thus, not work in PWS subjects. AIM: To test whether the estimation of FFM from bioelectrical impedance analysis (BIA) in PWS subjects requires population-specific equations. METHODS: Using dual-energy X-ray absorptiometry, this study measured FFM in 27 PWS and 56 non-PWS obese women and evaluated its association with the impedance index at 50 kHz (ZI50), i.e. the ratio between squared height and whole-body impedance at 50 kHz. RESULTS: At the same level of ZI50, PWS women had a lower FFM than non-PWS women. However, when PWS-specific equations were used, FFM was accurately estimated at the population level. An equation employing a dummy variable coding for PWS status was able to explain 85% of the variance of FFM with a root mean squared error of 3.3 kg in the pooled sample (n = 83). CONCLUSION: Population-specific equations are needed to estimate FFM from BIA in obese PWS women.

Spinal Postures and Mobility in Children with Achondroplasia vs. Age- and Sex-Matched Healthy Individuals: A Preliminary Report.

Background: Achondroplasia is a rare genetic disease, yet the most common form of dwarfism, characterized by limb shortening and disproportionate short stature along with musculoskeletal changes, such as postural deviations. Although postural changes in the spine in children with achondroplasia have been well investigated, little is known about the association of achondroplasia with spinal movements/mobility. Methods: This preliminary study aims to explore the association of achondroplasia with spinal mobility in children with achondroplasia compared to age- and sex-matched healthy individuals. Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Between-group differences were determined using a two-way analysis of variance. Results: Children with achondroplasia had smaller thoracic lateral flexion [difference between groups (Δ) = 20.4°, 95% CI 0.1°-40.6°, p = 0.04], lumbar flexion (Δ = 17.4°, 95% CI 5.5°-29.4°, p = 0.006), lumbar extension (Δ = 14.2°, 95% CI 5.7°-22.8°, p = 0.002) and lumbar lateral flexion (Δ = 19.6°, 95% CI 10.7°-28.4°, p < 0.001) than age- and sex-matched healthy individuals, except for thoracic extension (Δ = 16.5°, 95% CI 4.4°-28.7°, p = 0.009) which was greater in children with achondroplasia. No differences were observed in global spinal postures between the two groups. Conclusions: Spinal mobility appears to be more influenced by achondroplasia than global spinal postures in childhood. These results also highlight the importance of considering the musculoskeletal assessment of segmental spinal postures and rehabilitative interventions aimed at promoting spinal flexibility in children with achondroplasia.

Association of Physical Performance with Mental and Physical Health-Related Quality of Life and Low Back Pain-Related Disabilities among Older Adults with Severe Obesity.

Background: Low back pain is one of the most prevalent musculoskeletal problems and continues to be the leading cause of disabilities worldwide. The aim of this study was to cross-sectionally investigate the association of physical performance with mental and physical health-related quality of life and low back pain-related disabilities among older adults with severe obesity. Methods: A total of 96 hospitalized older adults with severe obesity (45 males, 51 females, age: 69.7 ± 5.4 years; BMI: 43.7 ± 5.7 kg/m2) were recruited into the study. Physical performance, health-related quality of life, and low back pain-related disability were measured through physical performance tests, the 12-item short-form survey (SF-12), and the Oswestry disability index, respectively. Results: LBP-related disabilities, as well as physical health-related quality of life, were associated with all the physiological parameters measured by physical performance tests, including muscular strength, aerobic capacity, balance, and lower body flexibility (p < 0.05). In contrast, mental health-related quality of life was associated with fewer physiological parameters, such as primarily muscular strength (p < 0.05). Conclusions: These findings could provide important insights for developing rehabilitation strategies designed to improve LBP-related disabilities, as well as the physical and mental health-related quality of life, in older adults with severe obesity.

Analysis of sarcopenic obesity prevalence and diagnostic agreement according to the 2022 ESPEN and EASO Consensus in hospitalized older adults with severe obesity.

Background: Sarcopenic obesity (SO) is a clinical disorder characterized by increased adiposity and decreased muscle mass and function, commonly observed in older adults. However, most of the studies that investigated SO prevalence rates were not based on current standardized diagnostic methods. Thus, this study aims to estimate the prevalence rates of SO and their level of agreement using different instruments proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) Consensus, in a sample of hospitalized older adults with severe obesity. Methods: A cross-sectional study with 90 older adults (≥ 60 years) with severe obesity (body mass index ≥ 35 kg/m/²) seeking an in-hospital multidisciplinary body weight reduction program. Skeletal muscle function was assessed using the five-repetition Sit-Stand test (5-SSt) and Handgrip Strength (HGS). Body composition was evaluated by high percentages of fat mass (FM), low appendicular lean mass (ALM/W), and skeletal muscle mass (SMM/W), adjusted to body weight. The stage of SO was assessed on the presence of at least one comorbidity and specific cut-offs were adopted for each step. All analyses were performed according to gender and age range. Results: The prevalence rates of SO in the total sample were 23.3%, 25.5%, 31.1%, and 40.0% considering altered values of 5-SSt+FM+ALM/W, HGS+FM+ALM/W, 5-SSt+FMSSM/W, and HGS+FM+SSM/W, respectively. Higher prevalence rates were observed among female and old elderly subgroups, regardless of the diagnostic combination. There were weak agreements between the muscle function tests (5-SSt versus HGS) using both muscle mass indexes in the total sample and all subgroups. Moderate agreements were observed between muscle mass indexes (SMM/W versus ALM/W) in the total sample, male and younger older adults (using 5-SSt), and strong agreements for men and younger older adults (using HGS). Conclusion: The discrepancies observed between the prevalence rates and their levels of agreement reinforce the need for new studies in similar populations aiming for better standardization of SO assessment.

Differences in spinal posture and mobility between adults with obesity and normal weight individuals.

The aim of this study was to cross-sectionally investigate the relationships between obesity and spinal posture as well as mobility by comparing the spinal parameters between adults with obesity and normal-weight individuals. The spinal parameters were measured in 71 adults with obesity and 142 normal-weight individuals using a radiation-free back scan, the Idiag M360. Differences in spinal posture and movements between the two groups were determined using a two-way analysis of variance. Adults with obesity had greater thoracic kyphosis [difference between groups (Δ) = 6.1°, 95% CI 3.3°-8.9°, p < 0.0001] and thoracic lateral flexion (Δ = 14.5°, 95% CI 5.1°-23.8°, p = 0.002), as well as smaller thoracic flexion (Δ = 3.5°, 95% CI 0.2°-6.9°, p = 0.03), thoracic extension (Δ = 4.1°, 95% CI 1.1°-7.1°, p = 0.008), lumbar flexion (Δ = 10.4°, 95% CI 7.7°-13.5°, p < 0.0001), lumbar extension (Δ = 4.8°, 95% CI 2.2°-7.4°, p = 0.0003) and lumbar lateral flexion (Δ = 12.8°, 95% CI 9.8°-15.7°, p = < 0.0001) compared to those with normal weight. These findings provide relevant information about the characteristics of the spine in adults with obesity to be taken into careful consideration in the prescription of adapted physical activities within integrated multidisciplinary pathways of metabolic rehabilitation.

Pulmonary and chest wall function in obese adults.

Obesity is frequently associated with breathing disorders. To investigate if and how the highest levels of obesity impact respiratory function, 17 subjects with obesity (median age: 49 years; BMI: 39.7 kg/m2, 8 females) and 10 normal-weighted subjects (49 years; 23.9 kg/m2, 5 females) were studied. The abdominal volume occupied 41% in the obese group, being higher (p < 0.001) than the normal-weighted group (31%), indicating accumulation of abdominal fat. Restrictive lung defect was present in 17% of subjects with obesity. At rest in the supine position, subjects with obesity breathed with higher minute ventilation (11.9 L/min) and lower ribcage contribution (5.7%) than normal weighted subjects (7.5 L/min, p = 0.001 and 31.1%, p = 0.003, respectively), thus indicating thoracic restriction. Otherwise healthy obesity might not be characterized by a systematic restrictive lung pattern. Despite this, another sign of restriction could be poor thoracic expansion at rest in the supine position, resulting in increased ventilation. Class 3 obesity made respiratory rate further increased. Opto-electronic plethysmography and its thoraco-abdominal analysis of awake breathing add viable and interesting information in subjects with obesity that were complementary to pulmonary function tests. In addition, OEP is able to localize the restrictive effect of obesity.

Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals.

Introduction: Spinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals. Methods: Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance. Results: Adults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight. Discussion: Although the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome.

Effects of combined training or moderate intensity continuous training during a 3-week multidisciplinary body weight reduction program on cardiorespiratory fitness, body composition, and substrate oxidation rate in adolescents with obesity.

This study aimed to investigate the effects of combined training (COMB, a combination of moderate-intensity continuous training-MICT and high-intensity interval training-HIIT) vs. continuous MICT administered during a 3-week in-hospital body weight reduction program (BWRP) on body composition, physical capacities, and substrate oxidation in adolescents with obesity. The 3-week in-hospital BWRP entailed moderate energy restriction, nutritional education, psychological counseling, and two different protocols of physical exercise. Twenty-one male adolescents with obesity (mean age: 16.1 ± 1.5 years; mean body mass index [BMI] 37.8 ± 4.5 kg m-2) participated in this randomized control trial study (n:10 for COMB, n:11 MICT), attending ~ 30 training sessions. The COMB group performed 3 repetitions of 2 min at 95% of peak oxygen uptake (V'O2 peak) (e.g., HIIT ≤ 20%), followed by 30 min at 60% of V'O2 peak (e.g., MICT ≥ 80%). Body composition, V'O2 peak, basal metabolic rate (BMR), energy expenditure, and substrate oxidation rate were measured during the first week (W0) and at the end of three weeks of training (W3). The two training programs were equivalent in caloric expenditure. At W3, body mass (BM) and fat mass (FM) decreased significantly in both groups, although the decrease in BM was significantly greater in the MICT group than in the COMB group (BM: - 5.0 ± 1.2 vs. - 8.4 ± 1.5, P < 0.05; FM: - 4.3 ± 3.0 vs. - 4.2 ± 1.9 kg, P < 0.05). V'O2 peak increased only in the COMB by a mean of 0.28 ± 0.22 L min-1 (P < 0.05). The maximal fat oxidation rate (MFO) increased only in the COMB group by 0.04 ± 0.03 g min-1 (P < 0.05). COMB training represents a viable alternative to MICT for improving anthropometric characteristics, physical capacities, and MFO in adolescents with obesity during a 3-week in-hospital BWRP.

Respiratory Muscle Interval Training Improves Exercise Capacity in Obese Adolescents during a 3-Week In-Hospital Multidisciplinary Body Weight Reduction Program.

The purpose of this study was to determine whether a novel approach of interval training targeted to the respiratory muscles (RMIT; normocapnic hyperpnea with resistance) in addition to a multidisciplinary in-hospital body weight reduction program (BWRP) was able to improve the integrative response to exercise in young patients with obesity. Nine male patients (17.9 ± 4.9 (x ± SD) years; 113.8 ± 16.3 kg) underwent 12 sessions of RMIT and eight age-and sex-matched patients underwent 12 sessions of a sham protocol (CTRL) during the same 3-week BWRP. Before and after the interventions the patients performed an incremental and a heavy-intensity constant work-rate (CWR>GET) cycling exercise to voluntary exhaustion. Body mass decreased by ~4.0 kg after both RMIT (p = 0.0001) and CTRL (p = 0.0002). Peak pulmonary O2 uptake (V˙O2) increased after RMIT (p = 0.02) and CTRL (p = 0.0007). During CWR>GET at ISO-time, V˙O2 (p = 0.0007), pulmonary ventilation (p = 0.01), heart rate (p = 0.02), perceived respiratory discomfort (RPER; p = 0.03) and leg effort (p = 0.0003) decreased after RMIT; only RPER (p = 0.03) decreased after CTRL. Time to exhaustion increased after RMIT (p = 0.0003) but not after CTRL. In young patients with obesity, RMIT inserted in a 3-week BWRP reduced the cardiorespiratory burden, the metabolic cost, the perceived effort, and improved exercise tolerance during heavy-intensity cycling.

Changes in the Oswestry Disability Index after a 3-Week In-Patient Multidisciplinary Body Weight Reduction Program in Adults with Obesity.

The aim of this study was to examine the short-term changes in disability after an inpatient, multidisciplinary body weight reduction program (BWRP) in adults with obesity. A total of 160 individuals (males: 52, females: 108, BMI > 35 kg/m2) hospitalized for a 3-week multidisciplinary BWRP were recruited into the study. Body composition, lower limb muscle power, fatigue severity, and disability were measured at the beginning and end of the intervention by means of bioimpedance analysis, a stair climbing test (SCT), the Fatigue Severity Scale (FSS), and the Oswestry disability index (ODI), respectively. At the end of the 3-week BWRP, an average body weight reduction of 5.0 kg (CI 95% −5.3; −4.6, p < 0.001) was determined, as well as an improvement in all parameters measured. Clinically meaningful reductions in disability were observed in the moderate disability (Δ = −11.8% CI 95% −14.3; −9.3, p < 0.001) and severe disability (Δ = −15.9% CI 95% −19.6; −12.2, p < 0.001) groups. Reductions in disability were explained only by improvements in the SCT (Δ = −2.7 CI 95% −4.1; −1.4, p < 0.001) and the FSS (Δ = −0.3% CI 95% −0.4; −0.1, p < 0.001). These findings demonstrate the importance of incorporating approaches into a BWRP that increase lower limb muscle power and decrease fatigue severity and thus reduce disability in adults with obesity.

Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults With Obesity.

Background: The aim of the present study was to examine the short-term changes in body composition and physical capabilities in subjects with obesity during a multidisciplinary inpatient body weight reduction program (BWRP). Methods: One hundred thirty-nine adolescents (56 boys and 83 girls; BMI: 37.1 ± 6.5 kg/m2; Fat Mass, FM: 45.3 ± 7.2%) and 71 adults (27 males and 44 females; BMI: 44 ± 4.7 kg/m2; FM: 51.4 ± 4.7%) followed a 3-week inpatient BWRP consisting of regular physical activity, moderate energy restriction, nutritional education and psychological counseling. Before (T0) and after the end of the BWRP (T21), body composition was assessed with an impedancemeter, lower limb muscle power with Margaria Stair Climbing Test (SCT), lower limb functionality with Short Physical Performance Battery (SPPB), and the capacity of performing activity of daily living (ADL) with Physical Performance Test (PPT). Results: At T21, obese adolescents showed a 4% reduction in body mass (BM) (p < 0.001), associated with a FM reduction in boys (-10%) and girls (-6%) (p < 0.001) and with a 3% reduction in fat-free mass (FFM) recorded only in boys (p = 0.013). Obese adults showed a 5% BM reduction (p < 0.001), associated with a 2% FFM and 9% FM reduction (p < 0.001) in males, and 7% FM reduction in females (p < 0.001). Regarding physical capabilities, at T21 in obese adolescents, PPT score increased by 4% (p < 0.001), SCT decreased by -5% (boys) and -7% (girls) (p < 0.001), while SPPB score did not change significantly. In obese adults at T21, PPT score increased by 9% (p < 0.001), SCT decreased by -16% (p < 0.001) only in females, and SPPB score increased by 7% (males) and 10% (females) (p < 0.01). Conclusion: In conclusion, moderate energy restriction and regular physical activity determine a 4-5% BM reduction during a 3-week inpatient BWRP, improve physical capabilities and induce beneficial changes in body composition in adolescents and adults with obesity. Trial registration: This study was approved by the Ethical Committee of the Istituto Auxologico Italiano (Milan, Italy; research code: 01C124; acronym: PRORIPONATFIS). Registered 11 November 2020 - Retrospectively registered.