Adherence and dropout in exercise-based interventions in childhood obesity: A systematic review of randomized trials.

Our objective was to systematically examine the characteristics of exercise interventions on adherence and dropout in children and adolescents with obesity. PubMed, Embase, PsycINFO, Lilacs, Scielo, and The Cochrane Central Register of Controlled Trials and reference lists of relevant articles were searched. We included randomized controlled trials with exercise interventions for pediatric patients with obesity presenting data on dropout and/or adherence. Two reviewers screened the records independently for eligibility with disagreements being resolved by a third reviewer. Twenty-seven studies with 1268 participants were included. Because of high heterogeneity and poor reporting of adherence, it was not possible to perform a meta-analysis. Dropout prevalence was calculated, and subgroup analyses comparing different types of exercise and a meta-regression with potential moderators were performed. We found a dropout rate of 13%. Subgroup analyses did not identify significant differences. The duration of the exercise presented a moderating effect on dropout, suggesting that longer exercise sessions may lead to higher dropout in children and adolescents with obesity. Because of the poor adherence data, it is not clear which exercise characteristics may moderate adherence. To improve the quality of childhood obesity care, it is mandatory that future studies present adherence data. Systematic review registration: PROSPERO CRD42021290700.

Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Preliminary evidence of glycine as a biomarker of cardiovascular disease risk in children with obesity.

Glycine (GLY) is a substrate for a wide range of metabolic processes. Several preclinical and adult studies demonstrated inverse associations of GLY with obesity, cardiovascular disease (CVD) and diabetes. However, little evidence is available on relationships between GLY and CVD risk in children. We assessed links between circulating GLY and biomarkers of CVD in children with obesity. Participants included both male and females with normal weight (NW, n = 6) and obesity (OB, n = 15), with age 14-18 years and Tanner stage >IV. Concentrations of GLY, branched chain amino acids (BCAA), and 25-hydroxy vitamin-D [25(OH)D], glucose, insulin, adiponectin, high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured using established techniques, and body composition by DXA. Homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. Our study identified major relationships of GLY (p-value < 0.01 for all) of GLY with visceral fat (r2 = 0.40), BCAA (r2 = 0.44), HOMA-IR (r2 = 0.33), 25(OH)D (r2 = 0.48), IL-6 (r2 = 0.46) and adiponectin (r2 = 0.39). Given that CVD progression is a continuum and the disease itself is not present in children and biomarkers are typically used to monitor CVD in children, the links between GLY and biomarkers of CVD provide evidence for the first time of a potential role for GLY in CVD in children with obesity.

Aerobic training with a self-selected or predetermined intensity on sleep parameters in adolescents with obesity: a randomized clinical trial.

Objectives: To compare the effects of self-selected and predetermined intensity on sleep quality and duration, daytime sleepiness, and sleep efficiency of adolescents with obesity after 12 weeks of aerobic training. Material and Methods: Thirty-seven adolescents (12 girls), 13-18 years old, with obesity (BMI = 95th) were randomized into a predetermined intensity group (PIG), exercise intensity around 60-70% of heart rate reserve; or self-selected intensity group (SIG), the adolescents chose the speed/intensity at the beginning of each session and were able to change it every 5 minutes. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to assess sleep outcomes. Results: No differences were observed for PSQI [0.00 ± 2.00 vs 1.38 ± 2.7; p=0.195; d=0.60 (moderate effect)], sleep duration [-0.95 ± 1.2 vs -0.35 ± 1.6; p=0.358; d=0.41 (small effect)], ESS [(2.10 ± 3.9 vs 1.15 ± 4.5; p=0.195; d=0.23 (small effect)], and sleep efficiency [(81.5 ± 24.0 vs 79.4 ± 17.0; p=0.8.14; d=0.10 (trivial effect)] for the PIG and SIG groups, respectively. Conclusion: Aerobic training at a self- selected or predetermined intensity does not modulate sleep quality, sleep duration and efficiency, and daytime sleepiness, independent of intensity.

Pulmonary function changes in older adults with and without metabolic syndrome.

The low-grade inflammation associated with metabolic syndrome (MS) triggers functional and structural alterations in several organs. Whereas lung function impairment is well reported for older adult population, the effect of MS on functional and immunological responses in the lungs remains unclear. In this cross-sectional study we determined whether MS alters pulmonary function, and immunological responses in older adults with MS. The study sample consisted of older adults with MS (68 ± 3 years old; n = 77) and without MS (67 ± 3 years old; n = 77). Impulse oscillometry was used to evaluate airway and tissue resistance, and reactance. Biomarkers of inflammation and fibrosis were assessed in the blood and in breath condensate. The total resistance of the respiratory system (R5Hz; p < 0.009), and the resistance of the proximal (R20Hz; p < 0.001) and distal (R5Hz-R20Hz; p < 0.004) airways were higher in MS individuals compared to those without MS. Pro-inflammatory (leptin, IL-1beta, IL-8, p < 0.001; TNF-alpha, p < 0.04) and anti-inflammatory cytokines (adiponectin, IL-1ra, IL-10, p < 0.001), anti-fibrotic (relaxin 1, relaxin 3, Klotho, p < 0.001) and pro-fibrotic (VEGF, p < 0.001) factors were increased in sera and in breath condensate individuals with MS. The results show that MS adversely affect lung mechanics, function, and immunological response in older adults. The data offer a metabolic basis for the inflammaging of the lungs and suggest the lungs as a potential therapeutic target for controlling the immune response and delaying the onset of impaired lung function in older adults with MS.

Barriers to physical activity during the COVID-19 pandemic in adults: a cross-sectional study.

Social isolation due to the coronavirus disease 2019 (COVID-19) pandemic has reduced physical activity levels in both men and women. The identification of barriers to physical activity may assist in developing strategies to increase levels of physical activity during this pandemic. The study aim was identify the barriers to regular participation in physical during the COVID-19 pandemic in Brazilian adults. This cross-sectional study included 1570 [56.6% women; aged: 39.1 (37.7-40.7) years old] in social isolation due COVID-19. Barriers to physical activity were obtained using the validated questionnaires. "Laziness and fatigue" (50.2%), "lack of motivation" (31.2%), "lack of appropriate facilities/equipment/space" (17.4%), and "lack of time" (13.0%) were the barriers most prevalent in the study. Lack of motivation (OR = 1.49; 95% CI = 1.19-1.86) and lack of appropriate facilities/equipment/space (OR = 2.11; 95% CI = 1.57-2.83) were most associated with impacting physical activity levels due to the COVID-19, independent of sex, age, education level, days of social isolation and status weight. In conclusion, personal barriers to physical activity are common between both sexes, with lack of motivation and lack of appropriate facilities/equipment/space most associated with a decreased level of physical activity due to the COVID-19 pandemic.

Increased Screen Time Is Associated With Alcohol Desire and Sweetened Foods Consumption During the COVID-19 Pandemic.

Background: Elevated screen time has been associated with addictive behaviors, such as alcohol and sugar intake and smoking. Considering the substantial increase in screen time caused by social isolation policies, this study aimed to analyze the association of increased screen time in different devices during the COVID-19 pandemic with consumption and increased desire of alcohol, smoking, and sweetened foods in adults. Methods: A sample of 1,897 adults with a mean age of 37.9 (13.3) years was assessed by an online survey, being composed by 58% of women. Participants were asked whether screen time in television, cell phone, and computer increased during the pandemic, as well as how much time is spent in each device. Closed questions assessed the frequency of alcohol and sweetened food consumption, smoking, and an increased desire to drink and smoke during the pandemic. Educational level, age, sex, feeling of stress, anxiety, depression, and use of a screen device for physical activity were covariates. Binary logistic regression models considered adjustment for covariates and for mutual habits. Results: Increased television time was associated with increased desire to drink (OR = 1.46, 95% CI: 1.12; 1.89) and increased sweetened food consumption (OR = 1.53, 95% CI: 1.18; 1.99), while an increase in computer use was negatively associated with consumption of alcohol (OR = 0.68, 95% CI: 0.53; 0.86) and sweetened foods (OR = 0.78, 95% CI: 0.62; 0.98). Increased cell phone time was associated with increased sweetened food consumption during the pandemic (OR = 1.78, 95% CI: 1.18; 2.67). Participants with increased time in the three devices were less likely to consume sweetened foods for ≥5 days per week (OR = 0.63, 95% CI: 0.39; 0.99) but were twice as likely to have sweetened food consumption increased during pandemic (OR = 2.04, 95% CI: 1.07; 3.88). Conclusion: Increased screen time was differently associated with consumption and desire for alcohol and sweets according to screen devices. Increased time in television and cell phones need to be considered for further investigations of behavioral impairments caused by the pandemic.

The same storm but not the same boat: Effects of COVID-19 stay-at-home order on mental health in individuals with overweight.

OBJECTIVE: To describe the effects of stay-at-home orders and social distancing during the coronavirus disease (COVID-19) outbreak on mental health and to compare these outcomes between individuals with normal weight and overweight. METHODS: This cross-sectional study included 1857 Brazilian adults, who were invited through social media to answer an online questionnaire from 5 May 2020 to 17 May 2020. The instrument included questions related to health behaviour, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Overweight was defined as body mass index (BMI) ≥ 25 Kg/m2 . Multiple logistic regression was conducted to identify whether overweight is associated with mental health variables. RESULTS: Women reported increased anxiety (36.5% vs 22.2%, P < .01), depression (16.2% vs 8.8%, P < .01), low self-esteem (19.8% vs 10.6%, P < .01), sadness (17.7% vs 10.2%, P < .01), and stress (29.5% vs 19.3%, P < .01) relative to men. Women with overweight are more likely to report higher feeling of anxiety (OR 1.62, CI 95% 1.22-2.14), depression (OR 1.79, CI 95% 1.25-2.55), low self-esteem (OR 1.82, CI95% 1.28-2.58) and sadness (OR 1.51, CI 95% 1.08-2.10), adjusted for age, social isolation days, educational level, chronic diseases, smoke, alcohol intake and physical activity. CONCLUSION: Women, specially those with overweight are more vulnerable to the deleterious effects of stay-at-home orders on mental health during the COVID-19 pandemic.

Immunometabolic Changes in Hepatocytes Arising from Obesity and the Practice of Physical Exercise.

Over the recent years, a particular interest was shown towards understanding the roles of excessive hepatic fat accumulation and the development of obesity-related diseases. While hepatic triacylglycerol accumulation seems to be a response to the systemic increase of insulin release, fatty acid metabolites contribute to the progression of non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH). It is widely accepted that NAFLD is a polygenic and multifactorial disease under the influence of critical behavioral factors such as overeating and sedentary lifestyles. The progression of the disease is proposed to include the accumulation of lipids in hepatocytes, but liver damage would be mainly initiated through an exaggerated activation of the immune system. This inflammatory response would be triggered by the increase in cytokine production followed by TLR-4 activation and NF-kB pathways. Interestingly, cytokines as IL-1ra, IL-4, IL-6 and IL-10 act as antiinflammatory in response to exercise and thus, could play an important role in the restoration of liver functions in diseased conditions. Strategies for healthy life behaviors including nutrition and regular physical exercise are recommended to counteract the dreadful effects of NAFLD. To beyond the classical effect of exercise for increasing energy expenditure and/or inducing negative energy balance, exercise also prevents and reverses the effects of disorders related to the immunometabolic profile. This suggests that exercise prescription may be an attractive alternative for the prevention of obesity and NAFLD. Thus, this review seeks to shed light on the inflammatory pathways regulating the beneficial effects of physical activity on obesity and NAFLD. We will clarify how physical activity intervenes to normalize inflammatory processes and prevent obesity and NAFLD. Finally, the exercise interventions should be individualized to facilitate behavioral and cognitive strategies in order to promote long-term adherence. A multidisciplinary approach including lifestyles, diet and exercise training interventions is considered as a "best practice" and displays the strongest liver benefits when it occurs simultaneously with weight loss.

Physical Activity and Heart Rate Variability in Adolescents with Abdominal Obesity.

Physical activity is a protective factor for autonomic dysfunction. However, whether this occurs in adolescents with abdominal obesity is still unclear. Thus, the aim of this study was to analyze the association between physical activity and heart rate variability (HRV) in adolescents with and without abdominal obesity. This cross-sectional study included 1152 boys (age: 17 ± 1 years). HRV measures of time (root mean square of the squared differences between adjacent normal RR intervals-RMSSD and the percentage of adjacent intervals over 50 ms-PNN50) and frequency domains (balance sympathetic-vagal-LF/HF) were evaluated, as well as total physical activity, commuting physical activity, leisure-time physical activity, and abdominal obesity. All physical activity domains were associated with better RMSSD, PNN50, and LF/HF in normal weight adolescents (p < 0.05), whereas in adolescents with abdominal obesity only leisure-time physical activity was associated with better PNN50 (b = 0.174, p = 0.035) independent of age, period of the day, body mass index, and blood pressure. In conclusion, higher leisure-time physical activity, but not total and commuting physical activity levels, was associated with improved HRV in adolescents with abdominal obesity.

Cardiorespiratory fitness in adolescents with obesity: a 6-month follow-up study / Aptidão Cardiorrespiratória em Adolescentes com obesidade: um estudo de seguimento de 6 meses

The aim of this study was to investigate whether the effects of a multidisciplinary intervention on cardiorespiratory fitness are maintained after 6-month follow-up in adolescents with obesity. One-hundred and seven adolescents with obe-sity were intentionally allocated in two groups: experimental or control. Adolescents in experimental group underwent a multidisciplinary intervention (supervised aerobic exercise, psychological, nutritional, and clinical counseling). Cardiorespiratory fitness (direct gas analysis), body composition (dual-energy-DXA), anthropometry and blood lipids were measured before intervention (baseline), at the end of the 24-week intervention (post-intervention) and six months after the end of the intervention (follow-up). Cardiorespiratory fitness reduced in control group with no changes in experimental group, and these differences were maintained in the follow-up assessment (control group: 24.2±4.4 ml.kg-1.min-1to 22.6±4.9 ml.kg-1.min-1; follow-up: 22.6±4.9 ml.kg-1.min-1 vs. experimental group: 28.0±4.0 ml.kg-1.min-1 to 29.7±4.0 ml.kg-1.min-1; follow-up: 28.9±5.7 ml.kg-1.min-1). Reductions in z-score body mass index (BMI) and increases HDL-C af-ter multidisciplinary intervention were maintained after a 6-month follow-up. In conclusion, the benefits of a multidisciplinary intervention on cardiorespiratory fitness, BMI and blood lipids are maintained after a 6-month follow-up. These findings indicate that multidisciplinary interventions produce long-term health consequences on cardiorespiratory fitness. Reinforcing the importance of lifestyle changes as a therapeutic approach for the treatment of obesity in adolescents.

O objetivo do presente estudo foi investigar se os efeitos da intervenção multidisciplinar sobre a aptidão cardiorrespiratória são mantidos após um período de segmento de 6 meses em adolescentes com obesidade. Cento e sete adolescentes com obesidade foram intencionalmente alocados em dois grupos: experimental e controle. Os adolescentes do grupo experimental foram submetidos a intervenção multidisciplinar composta por acompanhamento psicológico, nutricional, clínico e treinamento aeróbio. Aptidão cardiorrespiratória (análise de gases), composição corporal (DEXA), antropometria e perfil lipídico foram avaliados no momento basal, após 24 semanas de intervenção e 6 meses após (follow up). A aptidão cardiorrespiratória reduziu no grupo controle sem alterações no grupo experimental, mesmo após o período de 6 meses (controle: 24,2±4,4 ml.kg-1.min-1 para 22,6±4,9 ml.kg-1.min-1; follow-up: 22,6±4,9 ml.kg-1.min-1 vs. grupo experimental: 28,0±4,0 ml.kg-1.min-1 para 29.7±4.0 ml.kg-1.min-1; follow-up: 28,9±5,7 ml.kg-1.min-1). Redução no escore-z do índice de massa corporal (Z-IMC) e elevação do HDL-c verificadas após 24 semanas, foram mantidas após o período de segmento. Os resultados indicam que os efeitos da intervenção multidisciplinar são mantidos após 6 meses de seguimento. Estes achados sugerem que intervenções multidisciplinares podem produzir alterações benéficas de longo prazo na capacidade cardiorrespiratória.

Effectiveness of a 16-month multi-component and environmental school-based intervention for recovery of poor income overweight/obese children and adolescents: study protocol of the health multipliers program.

BACKGROUND: Excess of weight is a serious public health concern in almost all countries, afflicting people of different ages and socioeconomic backgrounds. Studies have indicated the need for developing treatment strategies that intervene directly in the obesogenic environment. This study aims to evaluate the effectiveness of a multi-component and environmental school-based intervention, lasting 16 months, on the recovery of the nutritional status of low-income children and adolescents with overweight/ obesity. METHODS/STUDY DESIGN: The study was conducted by the Center for Recovery and Nutritional Education (CREN) in São Paulo, Brazil. Two schools located in poor neighborhoods were selected for the intervention, between March 2016 and June 2017. The participants were all students aged 8 to 12 years from the two participating schools. At the beginning of the intervention, anthropometric measurements were carried out to assess the nutritional status of the students. For convenience, students from one of the schools were considered as the control group, while those from the other school formed the experimental group. The intervention in the experimental group (n = 438) consists of the following weekly activities at school: psychological counseling in groups, theoretical/practical nutrition workshops, and supervised physical education classes. In addition, theoretical and practical educational activities are held regularly for parents, teachers, and cooks. Students with excess of weight (≥1 body mass index [BMI] -for-age Z score, n = 138) received clinical and nutritional care periodically at the outpatient care at CREN. Students enrolled in the control group (n = 353) participated in psychological counseling groups and theoretical/practical nutrition workshops for 6 months held in the school environment to provide motivation to entire classrooms. In the following 10 months, students with excess of weight from the control group (n = 125) were invited to attend the routine outpatient care at CREN. DISCUSSION: This study is the first to assess the effectiveness of a multi-component and environmental school-based intervention for the recovery of low-income, overweight/obese children and adolescents. If positive, the results demonstrate the feasibility for the recovery of excess of weight in populations of similar conditions and age. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials - ReBEC Primary Id Number RBR-9t2jr8 . Registration Date: Nov. 30, 2016. Retrospectively registered. Protocol version: 3.

Associations Between Cardiorespiratory Fitness and Overweight With Academic Performance in 12-Year-Old Brazilian Children.

Obesity has been associated with poor academic achievement, while cardiorespiratory fitness (CRF) has been linked to academic success. PURPOSE: To investigate whether CRF is associated with academic performance in Brazilian students, independently of body mass index (BMI), fatness and socioeconomic status (SES). METHODS: 392 5th and 6th grade students (193 girls) (12.11 ± 0.75 years old) were evaluated in 2012. Skinfold thickness measures were performed, and students were classified according to BMI-percentile. CRF was estimated by a 20-meter shuttle run test, and academic achievement by standardized math and Portuguese tests. Multiple linear regression analyses were conducted to explore the association between academic performance and CRF, adjusted for SES, skinfold thickness or BMI-percentile. RESULTS: Among girls CRF was associated with higher academic achievement in math (ß = 0.146;p = .003) and Portuguese (ß = 0.129;p = .004) in crude and adjusted analyses. No significant association was found among boys. BMI was not associated with overall academic performance. There was a weak negative association between skinfold thickness and performance in mathematics in boys (ß =- 0.030;p = .04), but not in girls. CONCLUSION: The results highlight the importance of maintaining high fitness levels in girls throughout adolescence a period commonly associated with reductions in physical activity levels and CRF.

Acute effects of high- and low-intensity exercise bouts on leukocyte counts.

BACKGROUND/OBJECTIVE: It is widely accepted that physical exercise may bring about changes in the immune system. Even acute bouts of exercise can alter the number and function of leukocytes, but the degree of white blood cell trafficking depends on the intensity and duration of exercise. The aim of this study was to analyze the acute and short-term effects of exercise intensity on leukocyte counts and leukocyte subsets. METHODS: Nine physically healthy, active young males (21.0 ± 1.9 years) underwent three experimental trials: high exercise intensity [80% peak oxygen consumption (VO2peak)], low exercise intensity (40% VO2peak), and the control condition (no exercise). Blood samples were collected prior to exercise, immediately after exercise, and 2 hours after exercise. Two-way analysis of variance for repeated measures was used to evaluate differences between the trials and the time-points, and to compare times within trials. RESULTS: There was a greater increase in the leukocyte count after high-intensity exercise, compared to the control condition (p < 0.01) and low-intensity exercise (p < 0.01). This effect was still present 2 hours after passive recovery (p < 0.01). CONCLUSION: When the same participants were submitted to different exercise intensities, the acute and short-term effects of exercise on white blood cells were intensity-dependent immediately after exercise (i.e., lymphocytosis and monocytosis) and 2 hours after passive recovery (i.e., neutrophilia).

Relationship between lipid and hematological profiles with adiposity in obese adolescents.

BACKGROUND: An excess of weight including obesity have reached epidemic rates in all age groups, both in developed and developing countries. It is notable that overweight children and adolescents have a higher likelihood of becoming obese adults and to present health-related problems early in life. OBJECTIVES: [corrected] To verify associations of the lipid and hematological profiles with adiposity in obese adolescents beginning multidisciplinary weight loss therapy. METHODS: This cross-sectional study was conducted with 85 adolescents of both genders, aged 12-19 years (Tanner staging 3 or 4) and body mass index greater than the 95(th) percentile. The sum of the triceps, subscapular and calf skinfolds and the waist circumference were used to estimate adiposity. Blood samples were collected from all patients after overnight fasting to analyze blood lipids (total cholesterol, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein and triglycerides), blood sugar and the hematological profile (hemoglobin, platelets and red blood cells). The Kolmogorov-Smirnov test and Spearman and Pearson correlation coefficients were used for statistical analysis with significance set for p-values ≤ 0.05. RESULTS: There were statistical differences between genders for red blood cells (p-value = 0.000), hemoglobin (p-value = 0.000) and platelets (p-value = 0.002). Positive correlations were found for red blood cells (p-value = 0.031) and hemoglobin (p-value = 0.024) with waist circumference. There was a negative correlation between hemoglobin and the sum of skinfolds (p-value = 0.022). CONCLUSION: The results demonstrate an association between the lipid and hematological profiles and body adiposity in obese adolescents thus reinforcing the importance of treating obese adolescents early to prevent health related problems in adult life.

Acute effects of aerobic exercise on mood and hunger feelings in male obese adolescents: a crossover study.

BACKGROUND: The aim of this study was to determine the acute effects of exercise intensity on anxiety, mood states and hunger in obese adolescents. METHODS: Subjects were eight male obese adolescents (age 15.44 ± 2.06 y; BMI 33.06 ± 4.78 kg/m2). Each subject underwent three experimental trials: (1) Control, seated for 30 min; (2) Low intensity exercise (LIE)--exercise at 10% below ventilatory threshold (VT); (3) High intensity exercise (HIE)--exercise at 10% above VT. Anxiety (STAI Trait/State), mood (POMS) and hunger (VAS) were assessed before and immediately after the experimental sessions. Comparisons between trials and times were assessed using Kruskal-Wallis and Wilcoxon tests, respectively. Associations between variables were described using a Spearman test. RESULTS: The largest increase in hunger was observed after LEI (914.22%). Both exercise sessions increased anxiety, fatigue and decreased vigor (p < 0.05). CONCLUSIONS: Acute exercise bouts are associated with negative changes in anxiety and mood, and with increases in hunger in obese adolescents.

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy.

BACKGROUND: Obesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents. METHODS: Sixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 +/- 4.18 kg/m2) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Turkey's test as post-hoc and Students T test. RESULTS: Long-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05). CONCLUSION: A long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents.

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. The aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. In conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.