Intervenciones de terapia ocupacional en el manejo de sobrepeso y obesidad: revisión sistemática exploratoria / Occupational therapy interventions for the management of overweight and obesity: scoping review

Introducción: Existe limitado conocimiento sobre las características y evidencia disponible de intervenciones de terapia ocupacional en el manejo y reducción de la obesidad y sobrepeso, traduciéndose en una limitada consideración en políticas y programas de salud. Objetivo: Caracterizar las intervenciones de terapia ocupacional en sobrepeso y/u obesidad. Métodos: Revisión Sistemática Exploratoria (Scoping Review) en las bases de datos EBSCOhost, Embase, PubMed, PsychInfo, Scielo y Scopus, de estudios publicados a junio 2020. Se usó estructura PRISMA ScR, incorporando artículos que cumplieran los criterios: a) Evaluasen una intervención de terapia ocupacional en sobrepeso y/u obesidad, b) Informasen resultados cuantitativos, y c) Publicados en revista con evaluación de pares. Resultados: Cinco estudios fueron incluidos en la revisión. Cuatro utilizaron un diseño cuasi experimental (pretest-postest, sin grupo de comparación), y un estudio utilizó un diseño mixto con estudio pretest-postest adicionando estudio cualitativo. Las intervenciones son heterogéneas y sus resultados atribuibles no fueron significativos en el desenlace reducción de peso corporal. Se relevan resultados favorables en otras dimensiones, como la resignificación del uso de tiempo libre y el aprendizaje de hábitos saludables. Discusión: Las intervenciones de terapia ocupacional refieren protocolos de intervención heterogéneos, asociados a programas de manejo de sobrepeso y obesidad. Los estudios disponibles proporcionan evidencia limitada su efectividad, y sus potenciales desenlaces son más consistentes con dimensiones psicosociales por sobre dimensiones morfológicas como el peso corporal. Se requiere con urgencia investigación experimental que permita establecer la acción de terapia ocupacional en estos problemas de relevancia para la salud pública.

Introduction: The knowledge about the characteristics and available evidence of occupational therapy interventions in the management of obesity and overweight is scarce, with also limited scalability of occupational therapy in health policies and programs. Objective: To characterize occupational therapy interventions for the management of overweight and/or obesity. Method: Scoping Review. EBSCOhost, Embase, PubMed, PsychInfo, Scielo and Scopus databases were included, with studies published from inception to June 2020. PRISMA ScR guidelines were used. Criteria for article selection included interventions that: a) Evaluated an occupational therapy intervention in overweight and/or obesity, b) Reported quantitative results, and c) Were published in a peer-reviewed journal, d) Full text available in English, Spanish, and Portuguese. Results: 5 studies were included in the review. Four studies corresponded to quasi-experimental design (pretest-posttest, no comparison group), and one study used a mixed-method design with a pretest-postest study adding a qualitative component. Interventions found were heterogeneous and changes were not significant for the outcome weight reduction. Significant results were found in other dimensions, such as resignification of the use of leisure time and the incorporation of healthy habits. Discussion: Occupational therapy interventions include heterogeneous protocols embedded in larger overweight and obesity management programs. Available studies provide limited evidence of their effectiveness, and their potential outcomes are more consistent with psychosocial dimensions than morphological ones, such as body weight. Experimental research is remarkably needed to establish the action of occupational therapy in these problems of public health relevance.

Effects of a Combined Endurance/Strength Training Program on Circulating Irisin Levels in Overweight/Obese Men and Women with Type 2 Diabetes Mellitus.

Irisin is a promising therapeutic target in patients with type 2 diabetes mellitus (T2DM), as studies have demonstrated that irisin can induce "browning" of adipocytes and mitigate pro-inflammatory conditions. Sex-specific changes in irisin levels have been reported in a study involving healthy men and women following physical training. The present study aims to analyze the effects of an 8-week training intervention on circulating irisin levels in patients with T2DM and to find out whether the training responses differ between T2DM men and women. Twenty-nine overweight/obese T2DM patients (19 men, 10 women; age: 46-74 years; body mass index >25 kg/m2) participated in a combined moderate-intensity endurance/strength training program (3 times a week). The irisin levels of men and women did not differ significantly. The post-training irisin levels did not differ significantly from the pre-training values, and there was no interaction effect of sex. This study shows no training-induced (sex-specific) changes in circulating irisin levels in T2DM patients. Large-scale studies using other forms of training are needed to fully clarify whether basal irisin levels can be changed in T2DM men and/or women to counteract T2DM.

Effect of telerehabilitation applied during COVID-19 isolation period on physical fitness and quality of life in overweight and obese individuals.

BACKGROUND/OBJECTIVES: The aim of the study was to examine the effects of exercise training through telerehabilitation applied during COVID-19 isolation period on overweight and obese individuals on physical fitness and quality of life. SUBJECTS/METHODS: In our study, 41 participants between the ages of 18-65 years and whose BMI values were 25 kg/m2 and above were randomly divided into two groups as telerehabilitation group (n: 21) and control group (n: 20). Exercise training applied to the telerehabilitation group with remote live connection included warm-up exercises, trunk stabilization exercises and breathing exercises under the supervision of a physiotherapist for 6 weeks, 3 days in a week. The control group was only informed about the importance of exercise for one session and evaluated at baseline and after 6 weeks. The physical fitness levels of individuals was assessed by Senior Fitness Test protocol and quality of life by Short Form-36. RESULTS: As a result of the study, statistically significant improvements were obtained in all parameters of physical fitness, quality of life in the telerehabilitation group (p < 0.05). In the difference values of the two groups, all parameters of physical fitness and quality of life were observed that there were statistically significant differences in favor of telerehabilitation group (p < 0.05). CONCLUSIONS: As a result, it was found that exercise training applied through telerehabilitation during the COVID-19 pandemic process was an effective, safe and viable approach in overweight and obese individuals. In the future, studies investigating the long-term effectiveness of telerehabilitation in this population are needed.

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients.

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0-100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps' skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1-t2, t2-t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2-t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.

Weight management and determinants of weight change in patients with coronary artery disease.

OBJECTIVE: To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD). METHODS: We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change. RESULTS: Intervention patients (n=280) lost significantly more weight than control patients (n=257) (-2.4±7.1 kg vs -0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59). CONCLUSION: The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight. TRIAL REGISTRATION NUMBER: NTR3937.

Physical activity motives, barriers, and preferences in people with obesity: A systematic review.

BACKGROUND: Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. METHODS: Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). RESULTS: From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity. CONCLUSIONS: Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.

Fitness, Fatness, and Mortality in Men and Women From the UK Biobank: Prospective Cohort Study.

Background Cardiorespiratory fitness may moderate the association between obesity and all-cause mortality (ie, the "fat-but-fit" hypothesis), but unaddressed sources of bias are a concern. Methods and Results Cardiorespiratory fitness was estimated as watts per kilogram from a submaximal bicycle test in 77 169 men and women from the UK Biobank cohort and combined with World Health Organization standard body mass index categories, yielding 9 unique fitness-fatness combinations. We also formed fitness-fatness combinations based on bioimpedance as a direct measure of body composition. All-cause mortality was ascertained from death registries. Multivariable-adjusted Cox regression models were used to estimate hazard ratios and 95% CIs. We examined the association between fitness-fatness combinations and all-cause mortality in models with progressively more conservative approaches for accounting for reverse causation, misclassification of body composition, and confounding. Over a median follow-up of 7.7 years, 1731 participants died. In our base model, unfit men and women had higher risk of premature mortality irrespective of levels of adiposity, compared with the normal weight-fit reference. This pattern was attenuated but maintained with more conservative approaches in men, but not in women. In analysis stratified by sex and excluding individuals with prevalent major chronic disease and short follow-up and using direct measures of body composition, mortality risk was 1.78 (95% CI, 1.17-2.71) times higher in unfit-obese men but not higher in obese-fit men (0.94 [95% CI, 0.60-1.48]). In contrast, there was no increased risk in obese-unfit women (1.09 [95% CI, 0.44-1.05]) as compared with the reference. Conclusions Cardiorespiratory fitness modified the association between obesity and mortality in men, but this pattern appeared susceptible to biases in women.

Acceptability of a structured diet and exercise weight loss intervention in breast cancer survivors living with an overweight condition or obesity: A qualitative analysis.

BACKGROUND: Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations. AIM: The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22-week weight loss lifestyle intervention. METHODS AND RESULTS: Participants completed semi-structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m2 . Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal-setting, meal-provisioning, self-awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal-provisioning, and dietary intake monitoring methods. CONCLUSION: Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal-provisioning and exercise regimes, provide transition tools, and allow participants to choose their self-monitoring method.

Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire.

BACKGROUND: Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF). AIM: The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]). DESIGN: Process validation of the ICF-OB schedule. SETTING: Baseline conditions of out- and in-patients. POPULATION: A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care. METHODS: A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m2) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals. RESULTS: We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes. CONCLUSIONS: The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity. CLINICAL REHABILITATION IMPACT: The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.

Moderate-Intensity Exercise and High-Intensity Interval Training Affect Insulin Sensitivity Similarly in Obese Adults.

OBJECTIVE: We compared the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on insulin sensitivity and other important metabolic adaptations in adults with obesity. METHODS: Thirty-one inactive adults with obesity (age: 31 ±â€…6 years; body mass index: 33 ±â€…3 kg/m2) completed 12 weeks (4 sessions/week) of either HIIT (10 × 1-minute at 90%HRmax, 1-minute active recovery; n = 16) or MICT (45 minutes at 70%HRmax; n = 15). To assess the direct effects of exercise independent of weight/fat loss, participants were required to maintain body mass. RESULTS: Training increased peak oxygen uptake by ~10% in both HIIT and MICT (P < 0.0001), and body weight/fat mass were unchanged. Peripheral insulin sensitivity (hyperinsulinemic-euglycemic clamp) was ~20% greater the day after the final exercise session compared to pretraining (P < 0.01), with no difference between HIIT and MICT. When trained participants abstained from exercise for 4 days, insulin sensitivity returned to pretraining levels in both groups. HIIT and MICT also induced similar increases in abundance of many skeletal muscle proteins involved in mitochondrial respiration and lipid and carbohydrate metabolism. Training-induced alterations in muscle lipid profile were also similar between groups. CONCLUSION: Despite large differences in training intensity and exercise time, 12 weeks of HIIT and MICT induce similar acute improvements in peripheral insulin sensitivity the day after exercise, and similar longer term metabolic adaptations in skeletal muscle in adults with obesity. These findings support the notion that the insulin-sensitizing effects of both HIIT and MICT are mediated by factors stemming from the most recent exercise session(s) rather than adaptations that accrue with training.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients.

BACKGROUND: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. OBJECTIVE: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. METHODS: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). RESULTS: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. CONCLUSION: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

Distinct abdominal and gluteal adipose tissue transcriptome signatures are altered by exercise training in African women with obesity.

The differential associations of adipose depots with metabolic risk during obesity have been proposed to be controlled by environmental and genetic factors. We evaluated the regional differences in transcriptome signatures between abdominal (aSAT) and gluteal subcutaneous adipose tissue (gSAT) in obese black South African women and tested the hypothesis that 12-week exercise training alters gene expression patterns in a depot-specific manner. Twelve young women performed 12-weeks of supervised aerobic and resistance training. Pre- and post-intervention measurements included peak oxygen consumption (VO2peak), whole-body composition and unbiased gene expression analysis of SAT depots. VO2peak increased, body weight decreased, and body fat distribution improved with exercise training (p < 0.05). The expression of 15 genes, mainly associated with embryonic development, differed between SAT depots at baseline, whereas 318 genes were differentially expressed post-training (p < 0.05). Four developmental genes were differentially expressed between these depots at both time points (HOXA5, DMRT2, DMRT3 and CSN1S1). Exercise training induced changes in the expression of genes associated with immune and inflammatory responses, and lipid metabolism in gSAT, and muscle-associated processes in aSAT. This study showed differences in developmental processes regulating SAT distribution and expandability of distinct depots, and depot-specific adaptation to exercise training in black South African women with obesity.

Modulation of inter-organ signalling in obese mice by spontaneous physical activity during mammary cancer development.

Accumulative evidence links breast cancer development to excess weight and obesity. During obesity, dysregulations of adipose tissue induce an increase in pro-inflammatory adipokine secretions, such as leptin and oestrogen secretions. Furthermore, a raise in oxidative stress, along with a decrease in antioxidant capacity, induces and maintains chronic inflammation, which creates a permissive environment for cancer development. Physical activity is recommended as a non-pharmacological therapy in both obese and cancer situations. Physical activity is associated with a moderation of acute inflammation, higher antioxidant defences and adipokine regulation, linked to a decrease of tumour-cell proliferation. However, the biological mechanisms underlying the relationship between oxidative stress, low-grade inflammation, carcinogenesis, obesity and physical activity are poorly understood. Our study is based on old, ovariectomised mice (C57BL/6J mice, 33 weeks old), fed with a high fat diet which increases adipose tissue favouring overweight and obesity, and housed in either an enriched environment, promoting physical activity and social interactions, or a standard environment constituting close to sedentary conditions. Our model of mammary carcinogenesis allowed for the exploration of tissue secretions and signalling pathway activation as well as the oxidative status in tumours to clarify the mechanisms involved in a multiple factorial analysis of the data set. The multiple factorial analysis demonstrated that the most important variables linked to moderate, spontaneous physical activity were the increase in growth factor (epithelial growth factor (EGF), hepatocyte growth factor (HGF)) and the activation of the signalling pathways (STAT3, c-jun n-terminal kinases (JNK), EKR1/2, nuclear factor-kappa B (NF-κB)) in the gastrocnemius (G). In inguinal adipose tissue, the NF-κB inflammation pathway was activated, increasing the IL-6 content. The adiponectin plasma (P) level increased and presented an inverse correlation with tumour oxidative status. Altogether, these results demonstrated that spontaneous physical activity in obesity conditions could slow down tumour growth through crosstalk between muscle, adipose tissue and tumour. A spontaneous moderate physical activity was able to modify the inter-organ exchange in a paracrine manner. The different tissues changed their signalling pathways and adipokine/cytokine secretions, such as adiponectin and leptin, resulting in a decrease in anti-oxidative response and inflammation in the tumour environment. This model showed that moderate, spontaneous physical activity suppresses tumour growth via a dialogue between the organs close to the tumour.

[Rehabilitation for patients with obesity]. / Rehabilitation bei Adipositas.

Inpatient rehab for people with obesity is much more than exercise therapy and nutritive education. It depends on many requirements such as adjusted rooms, special furniture and systems for determining the resting metabolic rate. An interdisciplinary treatment concept is needed to come up to the individual internal, orthopedic and psychological requirements of this complex syndrome. Growing up in an obese promotional environment many patients are suffering from depression, anxiety and eating disorders. Without focussing on these comorbidities it seems not promising to come to a permanent change of motivation. In this article we disbribe the surrounding conditions of an residential therapy in which the patient feels understood and can gain a new self-conception for a long-lasting weight loss.

Impact of Physical Training Programs on Physical Fitness in People With Class II and III Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease. PURPOSE: The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity. DATA SOURCES: Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017. STUDY SELECTION: This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article. DATA EXTRACTION: Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached. DATA SYNTHESIS: Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias. LIMITATIONS: The large variability of outcomes and interventions made comparisons difficult. CONCLUSIONS: A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.

Understanding occupational engagement for individuals with bariatric needs: The perspectives of Australian Occupational Therapists.

INTRODUCTION: Over the last 20 years, the number of individuals affected by obesity in Australia has increased by 56%. The impact of excessive weight gain results in a wide range of physical, psychological and social difficulties, with resultant changes to occupational performance and engagement. For some people within this population, a further consequence of this increasing weight gain contributes to additional difficulties, with the individual being considered to be "bariatric". For these people, resultant changes include decreased capacity to engage in self-care activities, leisure occupations and productive roles, creating significant difficulties in undertaking important life roles. This phenomenological study aimed to understand the occupational engagement of individuals with bariatric needs, and to identify potential opportunities to support the engagement and participation of these individuals from the perspectives of Australian occupational therapists. METHODS: Qualitative data were collected from 11 semi-structured interviews with occupational therapists from a variety of practice settings. RESULTS: Thematic analysis identified four central themes (a) Occupational engagement was significantly impacted by a lack of suitable resources and availability of daily living equipment; (b) Health and well-being were impacted by a disruption in meaningful occupational engagement; (c) Occupational roles were limited due to poor occupational identity and perceptions of not belonging within the community; (d) Occupational therapists do have a varied role when working with individuals with bariatric needs. CONCLUSION: Occupational therapists engaged in this study indicated that people with bariatric needs were significantly impacted by many complex issues as a result of their health condition, often contributing to poor health and decreased well-being. Occupational therapists are well-placed to engage with individuals with bariatric needs across many care contexts and must take up potential opportunities to provide services targeted towards the increased engagement and participation of these individuals, with resultant improvements to health and well-being.

Using Continuous Glucose Monitoring to Motivate Physical Activity in Overweight and Obese Adults: A Pilot Study.

BACKGROUND: Regular physical activity (PA) is associated with a lower risk of several types of cancers. However, two-thirds of overweight/obese adults are not sufficiently active; this, in combination with the unfavorable effect of excess body weight, puts them at a greater risk for cancer. One reason that these individuals do not engage in enough PA may be their lack of motivation to change their current behavior due to the perception of putting in effort for possible future gain without obvious short-term benefits. There is a need for innovative ways to help individuals recognize the immediate health benefits of PA and thus increase their motivation. METHODS: This pilot intervention tested a PA education module that included a one-on-one counseling session highlighting the acute effects of PA on glucose patterns, followed by a 10-day self-monitoring period with a continuous glucose monitor (CGM) and a Fitbit tracker. Participants rated the acceptability of the education module on a 5-point Likert scale and completed surveys assessing stages of change for motivational readiness. RESULTS: Nineteen overweight/obese adults (84% female) completed the study. Participants gave high ratings to the counseling session for improving their PA-related knowledge (mean = 4.22), increasing motivation (mean = 4.29), and providing personally relevant information (mean = 4.35). The summary acceptability scores for the self-monitoring period were 4.46 for CGM and 4.51 for Fitbit. Participants reported a significant decrease in the precontemplation stage and an increase in the action stage (P < 0.05). CONCLUSIONS: CGM is a feasible tool for PA interventions. IMPACT: Information from CGM could be used as biological-based feedback to motivate PA.See all articles in this CEBP Focus section, "Modernizing Population Science."

Cardiorespiratory Fitness, Body Mass Index, and Markers of Insulin Resistance in Apparently Healthy Women and Men.

BACKGROUND: Insulin resistance may be present in healthy adults and is associated with poor health outcomes. Obesity is a risk factor for insulin resistance, but most obese adults do not have insulin resistance. Fitness may be protective, but the association between fitness, weight, and insulin resistance has not been studied in a large population of healthy adults. METHODS: A cross-sectional analysis of cardiorespiratory fitness, body mass index, and markers of insulin resistance was performed. Study participants were enrolled at the Cooper Clinic in Dallas, Texas. The analysis included 19,263 women and 48,433 men with no history of diabetes or cardiovascular disease. Cardiorespiratory fitness was measured using exercise treadmill testing. Impaired fasting glucose (100-125 mg/dL) and elevated fasting triglycerides (≥150 mg/dL) were used as a markers of insulin resistance. RESULTS: Among individuals with normal weight, poor fitness was associated with 2.2-fold higher odds of insulin resistance in women (1.4-3.6; P = .001) and 2.8-fold higher odds in men (2.1-3.6; P <.001). The impact of fitness remained significant for overweight and obese individuals, with the highest risk group being the unfit obese. Among obese women, the odds ratio for insulin resistance was 11.0 for fit women (8.7-13.9; P <.001) and 20.3 for unfit women (15.5-26.5; P <.001). Among obese men, the odds ratio for insulin resistance was 7.4 for fit men (6.7-8.2; P < .001) and 12.9 for unfit men (11.4-14.6; P < .001). CONCLUSIONS: Independent of weight, poor fitness is associated with risk of insulin resistance. Obese individuals, particularly women, may benefit from the greatest absolute risk reduction by achieving moderate fitness.

ß2 adrenergic interaction and cardiac autonomic function: effects of aerobic training in overweight/obese individuals.

PURPOSE: To verify the influence of different volumes and intensities of aerobic exercise on cardiac autonomic function (CAF) through heart rate variability (HRV) analysis as well the influence of ß2 adrenergic receptor (ADRB2) variants in overweight/obese individuals. METHODS: 70 physically inactive adults were randomly allocated into the following 16-week training: 1-high-intensity interval training (HIIT) (n = 25, 1 × 4 min bout at 85-95%HR peak, 3×/week), 4-HIIT (n = 26, 4 × 4 min bouts at 85-95%HR peak, interspersed with 3 min of recovery at 50-70%HR peak, 3×/week), and moderate continuous training (MCT) (n = 19, 30 min at 60-70%HR peak, 5×/week). Before and after the exercise training, anthropometric, BP, cardiorespiratory fitness, and HRV measures were evaluated. R-R intervals recorded for 10 min in a supine position at pre- and post-intervention were used to analyze HRV in the plot-Poincare indexes (SD1, SD2), and frequency-domain (LF, HF, LF/HF). Full blood samples were used for genotyping. RESULTS: 4-HIIT and MCT showed positive outcomes for almost all variables while 1-HIIT had a positive influence only on SBP and SD2 index. No associations were observed between isolated ADRB2 variants and changes in HRV. In the analysis of the interaction genotypes, all groups responded positively for the SD1 index of HRV and only the H1 (GG and CC) and H2 (GG and CG + GG) groups presented increases in the RMSSD index. Furthermore, there was an increase in the LF index only in the H3 (CC and AA + AG) and H4 (AA + AG and CG + GG) groups. CONCLUSIONS: ADRB2 variants and aerobic exercise training are important interacting variables to improve autonomic function and other health variables outcomes in overweight or obese individuals.

Exploring the effectiveness of an 18-month weight management intervention in adults with Down syndrome using propensity score matching.

BACKGROUND: Down syndrome (DS) is one of the most common birth defects in the USA associated with high levels of overweight and obesity. Unique characteristics of adults with DS that may contribute to the high levels of obesity are high rates of hypothyroidism, poor muscle tone, altered gait and lower resting metabolic rate. Due to these factors, it is unknown if the same weight management interventions that are effective in adults with intellectual or developmental disability (IDD) without DS are as effective in those with DS. Therefore, the purpose of this secondary analysis was to compare changes in weight, diet and physical activity between participants with DS-related and non-DS-related IDD participating in an 18-month weight management trial. METHODS: We used propensity score methods to adjust baseline variables of overweight/obese adults with and without DS participating in an 18-month effectiveness trial with 6 months weight loss and 12 months weight maintenance. Participants followed one of two reduced calorie diet plans, obtained 150 min of moderate-vigorous intensity physical activity (MVPA) per week, and logged dietary intake daily. A health educator held monthly at-home visits with participants and a caregiver to give feedback on intervention compliance. RESULTS: Out of the 124 participants that met the criteria for inclusion, 21 were diagnosed with DS and 103 with non-DS-related IDD. Twenty out of 21 participants with DS were successfully matched. Clinically significant weight loss was seen at 18 months in participants with DS (-5.2%) and non-DS-related IDD (-6.8%), with no difference between groups (P = 0.53). Significant reductions in energy intake were seen across the 18-month intervention in both DS and non-DS-related IDD groups with between-group differences at 12 months only (1119 vs. 1492 kcal/day, respectively; P = 0.003). Although MVPA did not increase in either group across the intervention, those with non-DS-related IDD had higher levels of MVPA compared with those with DS across 18 months. CONCLUSION: Participants with DS lost a clinically significant amount of weight across the 18-month intervention. Compared with those with non-DS-related IDD, those with DS lost similar amounts of weight, had similar decreases in energy intake and participated in less MVPA across the 18-month intervention. Although individuals with DS have physiological factors that may contribute to obesity, weight management interventions designed for individuals with IDD may be equally effective in this population.