Higher energy flux may improve short-term appetite control in adolescents with obesity: the NEXT study.

Recent evidence suggests better appetite control in states of high-energy flux (HEF) in adults and lean children. Nevertheless, it is unknown whether this extends to youth with obesity. This study compares the effects of low, moderate or HEF on short-term appetitive control in adolescents with obesity. Sixteen adolescents with obesity (12-16 years, Tanner stages 3-5, 11 females) randomly completed three conditions: (i) low-energy flux (LEF); (ii) moderate energy flux (MEF; + 250 kcal) and (iii) HEF (HEF; + 500 kcal). Energy flux was achieved in MEF and HEF through elevated energy intake (EI) and concomitant increase in energy expenditure using cycling exercise (65 % VO2peak). Ad libitum EI, macronutrient intake and relative EI were assessed at dinner, subjective appetite sensations taken at regular intervals and food reward measured before dinner. Ad libitum EI at dinner was greater in LEF compared with HEF (P = 0·008), and relative EI (REI) was higher in LEF compared with MEF (P = 0·003) and HEF (P < 0·001). The absolute consumption of carbohydrates was lower in LEF compared with MEF (P = 0·047) and HEF (P < 0·001). Total AUC for hunger and desire to eat was lower in HEF compared with LEF (P < 0·001) and MEF (P = 0·038). Total AUC for prospective food consumption was lower on HEF compared with LEF (P = 0·004). Food choice sweet bias was higher in HEF (P = 0·005) compared with LEF. To conclude, increasing energy flux may improve short-term appetite control in adolescents with obesity.

Sport participation, weight status, and physical fitness in French adolescents.

The primary objective of this study was to investigate the associations between sport participation and weight status with physical fitness among French adolescents. The secondary aim was to establish sex- and age-specific physical fitness percentiles for French adolescents. The sample comprised 8084 adolescents (4126 boys, 3958 girls), aged 10-14 years. Participants were tested on cardiorespiratory fitness and muscular strength using the following tests: 20-m shuttle run test and handgrip strength test. A questionnaire on organized sport participation was completed. Physical fitness levels were better in boys (P < 0.005). Handgrip strength increased with age whereas 20-m shuttle run performance decreased with age. Overweight and obese adolescents had significantly lower cardiorespiratory fitness levels than their normal-weight peers (P < 0.005), whereas normal-weight adolescents had lower cardiorespiratory fitness than thin adolescents (P < 0.005). Sport participation was higher for boys (57.2% boys vs. 52.8% girls) (P < 0.001). Adolescents who participated in at least one organized sport (either through a club or at school) were fitter than those who did not participate in organized sports (P < 0.005). Adolescents who engaged in organized sports were more active and physically fit than those who did not participate. The fitness benefits of club sports are greater than those provided by school-based sports, highlighting the potential of sports clubs as a key setting for promoting health. What is Known: • Physical fitness is a strong marker of health in children and adolescents. • The last French Report Card highlighted the lack of fitness data and the need for nationwide programs, while showing a significant decline in cardiorespiratory fitness among youth in recent decades.. What is New: • This study reveals that adolescents participating in organized sports have better physical fitness compared to their peers who do not, emphasizing the potential advantages of club sports over school-based activities. • We highlight the need for targeted strategies, particularly for overweight or obese adolescents and girls, to increase participation in organized sports and enhance health outcomes. • The study emphasizes the need to develop policies that improve access to organized sports clubs and expand physical education in schools, aiming to improve CRF in adolescents.

Effects of portable pedal machines at work on lipoprotein subfraction profile in sedentary workers - the REMOVE study.

BACKGROUND: Sedentary behaviour at work is a major cause of atherosclerosis, particularly in tertiary workers. However, no studies have ever assessed the effect of active workstation on lipoprotein subfraction profile. This study aimed to evaluate the effect of 12-week portable pedal machines (PPMs) on lipoprotein subfraction profile among healthy sedentary workers. METHODS: Healthy administrative workers were randomized into an intervention group using PPMs for 12 weeks or a control group using normal-desk. Lipoprotein subfractions were assessed using Lipoprint® electrophoresis. Main outcomes were explored using mixed models with sensitivity analyses (four models). RESULTS: We included 40 participants (43.7 ± 8.6 years old, 100% women, BMI 23.8 ± 3.4 kg/m2; sedentary time at work 7.7 ± 1.8 h/day). Groups did not differ at baseline in any outcomes. 32 participants finished the trial. Changes in lipoprotein subfractions were especially marked for LDL profile. There was an interaction time x group for all parameters related to LDL and their subfractions: total LDL-cholesterol (p = 0.012), LDL particle size (p = 0.027), large LDL subfractions 1 and 2 (p = 0.001), and small dense LDL subfractions 3 to 7 (p = 0.046), using the crude model. The interaction reflects difference in the direction of changes between groups. The LDL particle size significantly increased in the intervention group (from 271.9 ± 2.5 at t0 to 272.8 ± 1.9 Ångström at t1, p = 0.037) while it did not change in the control group (272.5 ± 1.7 at t0 to 271.8 ± 1.5Å at t1, p = 0.52). All interactions were constantly significant whatever the models. Influencing variables were mainly stress at work that was associated with an increase in total LDL-cholesterol (coefficient 3.15, 95CI 0.20 to 6.11 mg/dl, p = 0.038), and BMI that was associated with Large-LDL, Large-HDL, IDL-C and triglycerides. CONCLUSIONS: Lipoprotein profile was improved after a 12-week PPMs intervention at work in healthy administrative workers. Changes were mainly showed for LDL and LDL subfractions. Lipoprotein profile was worsened by stress at work, BMI and age. TRIAL REGISTRATION: NCT04153214.

Constitutional thinness might be characterized by physiologically adapted and not impaired muscle function and architecture: new results from the NUTRILEAN study.

PURPOSE: While muscle mass and skeletal muscle fibers phenotype have been shown atypical in constitutional thinness (CT), force production capacities and its architectural determinants have never been explored. The present study compared muscle functionality and architecture between participants with CT and their normal-weight (NW) counterparts. METHODS: Anthropometry, body composition (Dual-X-ray Absorptiometry), physical activity/sedentary behavior (ActiGraph wGT3X-BT), ultrasound recording of the Vastus Lateralis (2D-ultrasound system), and functional capacities at maximal isometric and isokinetic voluntary contractions (MVCISO and MVCCON) during knee extension (isokinetic dynamometer chair Biodex) have been measured in 18 women with CT (body mass index < 17.5 kg/m2) and 17 NW women. RESULTS: A lower fat-free mass (ES: -1.94, 95%CI: -2.76 to -1.11, p < 0.001), a higher sedentary time, and a trend for a lower time spent at low-intensity physical activity, were observed in CT vs NW participants. While absolute MVCISO, MVCCON, rate of torque development (RTD), and torque work were all markedly lower in CT, these differences disappeared when normalized to body or muscle mass. Muscle thickness and fascicle length were found lower in CT (ES: -1.29, 95%CI: -2.03 to -0.52, p < 0.001; and ES: -0.87, 95%CI: -1.58 to -0.15, p = 0.02, respectively), while pennation angle was found similar. CONCLUSION: Despite lower absolute strength capacities observed in CT, present findings support the hypothesis of physiological adaptations to the low body and muscle mass than to some intrinsic contractile impairments. These results call for further studies exploring hypertrophy-targeted strategies in the management of CT.

Similar maximal aerobic capacity but lower energy efficiency during low-to-moderate exercise in women with constitutional thinness: new results from the NUTRILEAN study.

PURPOSE: Individuals with constitutional thinness have been presented with a lower muscular energy metabolism at the cellular level but their effective aerobic capacities and exercise-related energy efficiency remains unexplored. The present study compares maximal and sub-maximal aerobic capacities between subjects with constitutional thinness and age-matched normal-weight ones. METHODS: Anthropometric measures, body composition (Dual-X-ray absorptiometry), physical activity and sedentary time (GT3x actigraphs), and maximal aerobic capacities (cycling V ˙ O 2peak test) were assessed in 18 constitutionally thin (CT-body mass index < 17.5 kg m-2) and 17 normal-weight (NW-body mass index between 20 and 25 kg m-2) women. Energy efficiency was assessed during a submaximal cycling test and a walking exercise. RESULTS: CT had a lower body mass and body mass index compared to NW. Absolute peak oxygen uptake and maximal aerobic power were lower in CT subjects compared to NW (ES: - 1.63 [- 2.40; - 0.86] and - 1.32 [- 2.05; - 0.58], p < 0.001). V ˙ O 2peak related to body mass was not different between groups. Gross and net efficiency (ES: - 0.78 [- 1.48; - 0.06], p = 0.03 and ES: - 0.73 [- 1.43; - 0.01], p = 0.05) were lower in CT compared to NW during the submaximal cycling exercise. The gross energy cost of walking related to body mass was lower in subjects with CT (ES: - 1.80 [- 2.60; - 0.97, p = 0.05), with no difference for the net one. Perceived exertion was similar between groups in responses to both submaximal exercises. CONCLUSION: Constitutionally thin women do not show impaired aerobic capacities at moderate to maximal intensities despite lower energy efficiency while cycling and walking at low-to-moderate intensities.

Individual variability and consistency of post-exercise energy and macronutrient intake, appetite sensations, and food reward in healthy adults.

Limited evidence is available about the variability of appetitive responses within individuals after an acute bout of exercise. The present study aimed to assess the consistency and individual variability of post-exercise appetitive responses in healthy individuals. Twenty participants (10 females, 23.9 ± 4.1 years, 22.5 ± 2.0 kg m-2) joined the laboratory to perform four sessions separated by a minimum of 5 days: i) a control session with a rest period before and an ad libitum lunch (REST), and ii) three identical exercise sessions (EX) with a 30-min moderate-intensity (60-70% of predicted maximal heart rate) walking bout ending 25 min before the ad libitum lunch. Subjective appetite sensations were assessed before and after the meal at regular intervals, and satiety quotients were calculated. Food reward was assessed by the Leeds Food Preference Questionnaire before and after lunch. For each EX session, the difference with the REST session was calculated (Δ = EX - REST). Energy and macronutrient intake were consistent in response to exercise (all intraclass correlation coefficients (ICC) > 0.8) while results showed that post-exercise subjective appetite sensations and satiety quotients varied across the three EX sessions (almost all ICC < 0.7). Food reward was overall consistent in response to exercise before the test meal but not after. When considering the changes (Δ), the results showed no or poor consistency for most of the appetitive outcomes. To conclude, energy and macronutrient intake, as well as pre-meal food reward, are consistent after exercise in healthy individuals, while subjective appetite sensations are not stable within individuals across the sessions. Regarding the variations from REST to EX sessions, the results suggest that the individual changes observed are only random day-to-day variations.

Post-exercise energy replacement might lead to reduced subsequent energy intake in women with constitutional thinness: Exploratory results from the NUTRILEAN project.

While people with Constitutional Thinness (CT) declare a deep willingness to gain weight, there appetitive responses to energy balance manipulations remain unclear. The present work compares the effect of an acute exercise combined or not with an energy replacement load, on subsequent energy intake, appetite and food reward, between normal weight and women with CT. Anthropometric measurements, body composition (Dual X-ray absorptiometry-DXA) and aerobic capacity (VO2max) were assessed in 10 normal-weight (Body Mass Index-BMI): 20-25 kg/m2) and 10 C T (BMI<17.5 kg/m2) women (18-30 years). They randomly performed i) a resting session (CON); ii) an exercise session (EX); iii) an exercise session with energy replacement (EX + R). Their subsequent ad libitum intake, appetite feelings and food reward were evaluated (Leeds-Food-Preference-Questionnaire). CT showed a lower weight (p < 0,001), BMI(p < 0,001), Fat-Mass (%) (p = 0,003) and Fat-Free Mass (kg) (p < 0,001). CT showed a lower ad libitum energy intake on EX + R compared with CON (p = 0,008) and a higher Relative Energy Intake (REI) on CON compared with EX (p = 0,007) and EX + R (p < 0,001). A lower was observed during EX and EX + R compared with CON (p = 0,006,p = 0,009 respectively) in CT. No condition nor group effect was found for hunger. NW only showed a higher pre-meal fullness on EX + R compared to CON and EX (p < 0,001). Choice (p = 0,030), Explicit Liking (p = 0,016), Explicit Wanting (p = 0,004) and Implicit Wanting (p = 0,035) for taste were higher on EX + R than CON and EX. The decreased EI observed in CT when the exercise-induced energy expenditure is compensated by the ingestion of an equivalent energy load, might contribute to explain the difficulty to increase their energy balance and then induce weight gain. Further studies are needed to better understand their energy balance regulation to propose adapted weight gain strategies.

The Impact of a Gamified Intervention on Daily Steps in Real-Life Conditions: Retrospective Analysis of 4800 Individuals.

BACKGROUND: Digital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts. OBJECTIVE: This study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program. METHODS: Data from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants' characteristics were included in multilevel models to test the study objectives. RESULTS: Participants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants' initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect. CONCLUSIONS: In real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants' initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants.

Challenges of considering both extremities of the weight status spectrum to better understand obesity: insights from the NUTRILEAN project in constitutionally thin individuals.

BACKGROUND/OBJECTIVES: While the physiology of obesity has been so extensively investigated to date, only an extremely small number of studies (less than 50) have focused on the other extremity of the weight spectrum: constitutional thinness. Yet, this important state of underweight in the absence of any eating disorders provides a mirror model of obesity that might be particularly insightful in understanding obesity. Nevertheless, important methodological and recruitment-related issues appear when it comes to this complex constitutionally thin phenotype, as experienced by our research group with the realization of the ongoing NUTRILEAN clinical trial. To face this challenge, the present paper aims at identifying, analyzing, and discussing the quality of such recruitment processes in publications about constitutional thinness. METHODS: In this order, a group of experts collectively created a new grading system to assess the level of rigour and quality achieved by each study based on different criteria. RESULTS: The main results were that (i) metabolic-related biasing criteria were poorly observed despite being crucial, (ii) recruitment processes were not detailed enough and with sufficient explicitness, and (iii) recruiting among already identified patients would be associated with both higher sample sizes and better scores of quality. CONCLUSIONS: The present work encourages investigators to adopt a high level of rigour despite the complexity and duration of recruitment processes for this specific population, and readers to pay close attention to the quality of recruitment when interpreting the data. To better understand obesity and its physiological adaptations, it seems essential not only to compare it to normal-weight conditions, but also to the other extremity of the weight status spectrum represented by constitutional thinness.

Is dieting a risk for higher weight gain in normal-weight individual? A systematic review and meta-analysis.

While there is an increasing prevalence of dieting in the overall population, weight loss (WL) practices could be a risk factor for weight gain (WG) in normal-weight (NW) individuals. The aim of the present work was to systematically review all the studies implicating diet restriction and body weight (BW) evolution in NW people. The literature search was registered in PROSPERO (CRD42021281442) and was performed in three databases from April 2021 to June 2022 for articles involving healthy NW adults. From a total of 1487 records initially identified, eighteen were selected in the systematic review. Of the eight dieting interventional studies, only one found a higher BW after weight recovery, but 75 % of them highlighted metabolic adaptations in response to WL favouring weight regain and persisting during/after BW recovery. Eight of the ten observational studies showed a relationship between dieting and major later WG, while the meta-analysis of observational studies results indicated that 'dieters' have a higher BW than 'non-dieters'. However, considering the high methodological heterogeneity and the publication bias of the studies, this result should be taken with caution. Moreover, the term 'diet' was poorly described, and we observed a large heterogeneity of the methods used to assess dieting status. Present results suggest that dieting could be a major risk factor for WG in the long term in NW individuals. There is, however, a real need for prospective randomised controlled studies, specifically assessing the relationship between WL induced by diet and subsequent weight in this population.

Weight loss does not affect the sit-to-stand metabolic cost in adolescents with obesity.

PURPOSE: There is considerable interest in simple and effective methods to reduce sitting time and increase energy expenditure, and standing breaks have emerged as a realisable approach in individuals with obesity. The aim of the present study was to determine the extent to which energy expenditure in standing differs from sitting, and whether this energetic and metabolic-related responses are modified following a weight loss program in adolescents with obesity. METHODS: After body composition assessment (DXA), cardiorespiratory and metabolic variables were continuously recorded (indirect calorimetry) during 10 min while sitting and then during 5 min standing posture before (n = 21; T1) and at the end of a multidisciplinary intervention (n = 17; T2) in adolescents with obesity. RESULTS: Before and after the intervention, energy expenditure and fat oxidation rates were significantly increased in standing compared with sitting. Weight loss did not change the relationship between sitting and standing energy expenditure. Sitting energy expenditure represented 1.0 and 1.1 Metabolic Equivalent of Task at T1 and T2, and increased to 1.1 and 1.2 during standing at T1 and T2, respectively. The percentage of change of android fat mass between T1 and T2 was positively associated with the percentage of change in energy expenditure from sitting to standing at T2. CONCLUSION: The vast majority of the adolescents with obesity significantly increased their energy expenditure between sitting and standing, both before and after a weight loss intervention. However, the standing posture did not allow breaking the sedentary threshold. Abdominal fat mass is associated with energic profile.

The energy content of meals with a similar macronutrient distribution may have a greater impact on appetite sensations than food preferences in adolescents with obesity: A secondary analysis.

PURPOSE: The energy and macronutrient composition of a meal has been shown to influence postprandial appetitive responses, but it is not clear how energy content independent of macronutrient distribution affects postprandial appetite in adolescents with obesity. Extracting data from a primary study testing the effect of energy turnover on appetite, this secondary analysis assessed how fixed meals varying in energy content with similar macronutrient distributions influences postprandial appetite sensations and food reward. METHODS: Using a randomised, counterbalanced crossover design, N = 14 adolescents with obesity (Mage = 12.71, SDage = 0.99; 10 female) consumed fixed lunch meals with similar macronutrient content starting at 750 kcal in energy and progressively increasing by 250 kcal on three different test days. Liking and wanting for food images varying in fat and taste were assessed at baseline and immediately after meal consumption. Appetite sensations were assessed in half-hour intervals from baseline to 1-h post-meal. RESULTS: The area under the curve for subjective hunger (p < .001, ω = 0.36), desire to eat (p < .001, ω = 0.54), and prospective food consumption (p = .004, ω = 0.32) were significantly lower after consumption of the higher calorie meals relative to the lowest. Explicit wanting for sweet foods increased after intake of the intermediate calorie meal yet decreased after the highest calorie meal (p = .014, ω = 0.09). Conversely, implicit wanting sweet bias increased after consumption of the test meal independent of energy content (p < .001, ω = 0.15). CONCLUSION: The consumption of additional calories without a meaningful change in macronutrient distribution may affect appetite sensations more reliably than hedonic responses to energy-dense foods in adolescents with obesity.

Dietary- but not exercise-induced acute iso-energetic deficit result in short-term appetitive compensatory responses in adolescents with obesity.

BACKGROUND: Producing negative energy balance rests on the creation of energy deficits that have been shown, depending on their modality, to induce potential appetitive compensatory responses. The aim of this study was to compare energy intake (EI), appetite feelings, and the hedonic responses to equivalent acute energy deficits induced by exercise versus energy restriction in adolescents with obesity. METHODS: In a within-participants design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 9 males) randomly completed three conditions: i) control (CON); ii) deficit induced by diet only (Def-EI); and iii) deficit induced by exercise only (Def-EX). Lunch was calibrated to generate a 400-kcal deficit in Def-EI and remained similar in CON and Def-EX. A 400-kcal deficit was created through a cycling bout set at 65% VO2peak in Def-EX. Ad libitum EI, macronutrient intake and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner. RESULTS: Food intake at dinner was greater in Def-EI (1112 ± 265 kcal) compared to CON (983 ± 277 kcal; p = 0.005) and Def-EX (1009 ± 281 kcal; p = 0.025). Absolute protein and lipid intake were significantly higher in Def-EI (52.4 ± 9.5 g and 36.8 ± 8.9 g respectively) compared with both CON (44.9 ± 12.6 g; p = 0.001 and 33.8 ± 10.1 g; p = 0.002 respectively) and Def-EX (47.3 ± 11.8 g, p = 0.018, 35.4 ± 10.1 g, p = 0.036 respectively). Area under the curve (AUC) for hunger, desire to eat and prospective food consumption were significantly higher in Def-EI compared with both CON (p = 0.0001) and Def-EX (p = 0.0001). AUC for fullness was significantly lower on Def-EI compared with CON and Def-EX (p = 0.0001). Implicit wanting for sweet food was significantly lower on Def-EX (p = 0.031), relative to CON. CONCLUSION: Appetitive compensatory responses that are observed after iso-caloric energy restriction in adolescents with obesity are absent with acute exercise, which could contribute to optimize our impact on short-term energy balance.

The Effects of Using a Cycling Desk at School on Executive Function, Physical Fitness, and Body Composition in Primary School Children: Impact of Socioeconomic Status.

CONTEXT: Physical inactivity and sedentary behaviors are associated with adverse health outcomes in both adults and children. The purpose of this study was to investigate the effects of a 9-week program using a Cycle Desk during school time in French primary school children from high or low socioeconomic status (SES) on body composition, physical fitness (PF), and executive function. METHODS: Seventy-five (n = 75) children completed a test battery before and after 9 weeks of use of Cycle Desk to evaluate anthropometric characteristics, body composition, PF, and executive function. RESULTS: Body mass index increased significantly (P = .0095), while body fat decreased after the use of Cycle Desks (P < .0001). Specifically, lean mass increased in the high-SES group while it decreased in the low-SES group (P < .0001). After 9 weeks, there was an improvement in motor skills (P < .0001), upper and lower limbs' strength (P < .0001), and executive function performance (P < .0001). More specifically, the low-SES group had a greater improvement in motor skills and maximal aerobic speed between T0 and T1, compared to the high-SES group (P = .001, P = .023, respectively). In contrast, the high-SES group had a greater improvement in executive function at 9 weeks of use of Cycle Desk compared with the low-SES group (P = .0084). CONCLUSIONS: The promotion of low-intensity physical activity with the use of a Cycle Desk at school may help offset some adverse effects of excess sedentary behavior among children. Moreover, this strategy appears to be particularly effective in children from low-SES backgrounds. What's New: The use of a Cycle Desk during school time has no deleterious effects on PF as well as cognitive executive functions in primary children. Modifications are more beneficial in children from low SES.

Effects of single and multiple sessions of lower body diastole-synchronized compressions using a pulsating pneumatic suit on endothelium function and metabolic parameters in patients with type 2 diabetes: two controlled cross-over studies.

BACKGROUND: Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions on microcirculation, endothelium function and metabolic parameters of patients with type 2 diabetes. METHODS: Two monocentric, controlled, randomized cross-over studies (Study 1 and Study 2) were performed. In Study 1, 16 patients received one 20 min DSCD and one simulated (control) session at 2 week intervals; continuous glucose monitoring and cutaneous blood flow were recorded continuously before, during and after DSCD or Control session; other vascular assessments were performed before and after DSCD and control sessions. In Study 2, 38 patients received 60 min DSCD sessions three times/week for three months followed by a 4-6 week washout and 3 month control period (without simulated sessions); vascular, metabolic, body composition, physical activity and quality of life assessments were performed before and after 3 months. RESULTS: Both studies showed significant, multiplex effects of DSCD sessions. In Study 1, cutaneous blood flow and endothelium function increased, and plasma and interstitial glucose levels after a standard breakfast decreased after DSCD sessions. In Study 2, cutaneous endothelium function improved, LDL-cholesterol and non-HDL cholesterol decreased, extra-cell water decreased and SF-36 Vitality score increased after 3 months of DSCD sessions. CONCLUSIONS: Our findings support the beneficial effect of DSCD on the endothelium and show concomitant beneficial metabolic and vitality effects. Future clinical trials need to test whether DSCD use translates into a preventive measure against microvascular diabetic complications and its progression. Trial registration ClinicalTrials.gov identifiers: NCT02293135 and NCT02359461.

COVID-19 lockdown consequences on body mass index and perceived fragility related to physical activity: A worldwide cohort study.

BACKGROUND: This paper is a follow-up study continuing the COVISTRESS network previous research regarding health-related determinants. OBJECTIVE: The aim was to identify the main consequences of COVID-19 lockdown on Body Mass Index and Perceived Fragility, related to Physical Activity (PA), for different categories of populations, worldwide. DESIGN: The study design included an online survey, during the first wave of COVID-19 lockdown, across different world regions. SETTING AND PARTICIPANTS: The research was carried out on 10 121 participants from 67 countries. The recruitment of participants was achieved using snowball sampling techniques via social networks, with no exclusion criteria other than social media access. MAIN OUTCOME MEASURES: Body Mass Index, Physical Activity, Perceived Fragility and risk of getting infected items were analysed. SPSS software, v20, was used. Significance was set at P < .05. RESULTS: Body Mass Index significantly increased during lockdown. For youth and young adults (18-35 years), PA decreased by 31.25%, for adults (36-65 years) by 26.05% and for the elderly (over 65 years) by 30.27%. There was a high level of Perceived Fragility and risk of getting infected for female participants and the elderly. Correlations between BMI, Perceived Fragility and PA were identified. DISCUSSION AND CONCLUSIONS: The research results extend and confirm evidence that the elderly are more likely to be at risk, by experiencing weight gain, physical inactivity and enhanced Perceived Fragility. As a consequence, populations need to counteract the constraints imposed by the lockdown by being physically active.

Costing the economic burden of prolonged sedentary behaviours in France.

BACKGROUND: There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France. METHODS: Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach. RESULTS: In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €. CONCLUSION: Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.

Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Gamification refers to the use of game elements in nongame contexts. The use of gamification to change behaviors and promote physical activity (PA) is a promising avenue for tackling the global physical inactivity pandemic and the current prevalence of chronic diseases. However, there is no evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature. OBJECTIVE: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of gamified interventions and their health care potential by testing the generalizability and sustainability of their influence on PA and sedentary behavior. METHODS: A total of 5 electronic databases (PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials published in English from 2010 to 2020. Eligibility criteria were based on the components of the participants, interventions, comparators, and outcomes framework. Studies were included when they used gamified interventions in daily life with an active or inactive control group and when they assessed a PA or sedentary behavior outcome. We conducted meta-analyses using a random-effects model approach. Sensitivity analyses, influence analyses, and publication bias analyses were performed to examine the robustness of our results. RESULTS: The main meta-analysis performed on 16 studies and 2407 participants revealed a small to medium summary effect of gamified interventions on PA behavior (Hedges g=0.42, 95% CI 0.14-0.69). No statistical difference among different subgroups (adults vs adolescents and healthy participants vs adults with chronic diseases) and no interaction effects with moderators such as age, gender, or BMI were found, suggesting good generalizability of gamified interventions to different user populations. The effect was statistically significant when gamified interventions were compared with inactive control groups, such as waiting lists (Hedges g=0.58, 95% CI 0.08-1.07), and active control groups that included a nongamified PA intervention (Hedges g=0.23, 95% CI 0.05-0.41). This suggests that gamified interventions are not only efficient in changing behavior but also more effective compared with other behavioral interventions. The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) was weaker, with a very small to small effect (Hedges g=0.15, 95% CI 0.07-0.23). CONCLUSIONS: This meta-analysis confirms that gamified interventions are promising for promoting PA in various populations. Additional analyses revealed that this effect persists after the follow-up period, suggesting that it is not just a novelty effect caused by the playful nature of gamification, and that gamified products appear effective compared with equivalent nongamified PA interventions. Future rigorous trials are required to confirm these findings.

Possible Impact of a 12-Month Web- and Smartphone-Based Program to Improve Long-term Physical Activity in Patients Attending Spa Therapy: Randomized Controlled Trial.

BACKGROUND: Lack of physical activity (PA) and sedentary behaviors are leading risk factors for noncommunicable diseases (NCDs). Web- and smartphone-based interventions are effective in increasing PA in older adults and in patients with NCD. In many countries, spa therapy, commonly prescribed to patients with NCD, represents an ideal context to initiating lifestyle changes. OBJECTIVE: This study aimed to evaluate, in patients attending spa therapy, the effectiveness of an intervention combining a face-to-face coaching and, when returning home, a web- and smartphone-based PA program on the achievement of PA guidelines (PAG) 12 months after the end of spa therapy. METHODS: This was a 12-month, prospective, parallel-group randomized controlled trial. Patients were enrolled during spa therapy and randomized 1:1 to intervention or control group who received PA usual advice. From the end of spa therapy, PA, weight, waist circumference, and quality of life of the participants were assessed by phone every 2 months. Primary outcome was meeting PAG (PA ≥600 metabolic equivalent of task) at 12 months. Secondary outcomes were meeting current PAG at 6 months; sedentary time, weight, waist circumference, PA, and quality of life at 6 and 12 months. Objective use data of the web- and smartphone-based PA program were collected. Analytic methods included intention to treat and constrained longitudinal data analyses. RESULTS: The study sample included 228 participants (n=176, 77.2% females) with a mean age of 62.4 (SD 6.7) years and a mean BMI of 28.2 (SD 4.2) kg/m2. Approximately 53.9% (123/228) of the participants were retired. No group differences were found for any baseline variable. At 12 months, the proportion of patients achieving PAG was significantly higher in intervention group than in the control group (81% vs 67% respectively, odds ratio 2.34, 95% CI 1.02-5.38; P=.045). No difference between intervention and control group was found neither in achieving PAG at 6 months nor for sedentary time, weight, and waist circumference at 6 and 12 months. Regarding quality of life, the physical component subscale score was significantly higher at 12 months in the intervention group than in the control group (mean difference: 4.1, 95% CI 1.9-6.3; P<.001). The mean duration use of the program was 7.1 (SD 4.5) months. Attrition rate during the first 2 months was 20.4% (23/113) whereas 39.8% (45/113) of the participants used the program for at least 10 months. CONCLUSIONS: PA increased in both the intervention group and the control group. However, at 12 months, more participants met PAG in the intervention group compared with the controls. This indicates that the web- and smartphone-based program could have maintained PA in the intervention group. In addition, a spa therapy seems to be an ideal time and framework to implement PA education. TRIAL REGISTRATION: ClinicalTrials.gov NCT02694796; https://clinicaltrials.gov/ct2/show/NCT02694796.

Fine Detection of Human Motion During Activities of Daily Living as a Clinical Indicator for the Detection and Early Treatment of Chronic Diseases: The E-Mob Project.

Methods to measure physical activity and sedentary behaviors typically quantify the amount of time devoted to these activities. Among patients with chronic diseases, these methods can provide interesting behavioral information, but generally do not capture detailed body motion and fine movement behaviors. Fine detection of motion may provide additional information about functional decline that is of clinical interest in chronic diseases. This perspective paper highlights the need for more developed and sophisticated tools to better identify and track the decomposition, structuration, and sequencing of the daily movements of humans. The primary goal is to provide a reliable and useful clinical diagnostic and predictive indicator of the stage and evolution of chronic diseases, in order to prevent related comorbidities and complications among patients.