Evaluation of a Supervised Adapted Physical Activity Program Associated or Not with Oral Supplementation with Arginine and Leucine in Subjects with Obesity and Metabolic Syndrome: A Randomized Controlled Trial.

Background: In patients with obesity and metabolic syndrome (MetS), lifestyle interventions combining diet, in particular, and physical exercise are recommended as the first line treatment. Previous studies have suggested that leucine or arginine supplementation may have beneficial effects on the body composition or insulin sensitivity and endothelial function, respectively. We thus conducted a randomized controlled study to evaluate the effects of a supervised adapted physical activity program associated or not with oral supplementation with leucine and arginine in MetS-complicated patients with obesity. Methods: Seventy-nine patients with obesity and MetS were randomized in four groups: patients receiving arginine and leucine supplementation (ALs group, n = 20), patients on a supervised adapted physical activity program (APA group, n = 20), patients combining ALs and APA (ALs+APA group, n = 20), and a control group (n = 19). After the baseline evaluation (m0), patients received ALs and/or followed the APA program for 6 months (m6). Body composition, MetS parameters, lipid and glucose metabolism markers, inflammatory markers, and a cardiopulmonary exercise test (CPET) were assessed at m0, m6, and after a 3-month wash-out period (m9). Results: After 6 months of intervention, we did not observe variable changes in body weight, body composition, lipid and glucose metabolism markers, inflammatory parameters, or quality of life scores between the four groups. However, during the CPET, the maximal power (Pmax and Ppeak), power, and O2 consumption at the ventilatory threshold (P(VT) and O2(VT)) were improved in the APA and ALs+APA groups (p < 0.05), as well as the forced vital capacity (FVC). Between m6 and m9, a gain in fat mass was only observed in patients in the APA and ALs+APA groups. Conclusion: In our randomized controlled trial, arginine and leucine supplementation failed to improve MetS in patients with obesity, as did the supervised adapted physical activity program and the combination of both. Only the cardiorespiratory parameters were improved by exercise training.

La douche préopératoire chez les patients obèses : ce qu'en disent les patients et les soignants.

Introduction : At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context : Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective : to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods : pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results : Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion : The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits : preliminary study with a small number of interviews and no non-obese patients.Conclusion : the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.