Lifestyle and resulting body composition in young athletes.

BACKGROUND: Key aspects in a lifestyle analysis are physical activity level and eating habits. An unhealthy lifestyle results in fat mass increase and in a predisposition to non-communicable chronic diseases even in young age. The purpose of this study was to investigate the lifestyle and body composition in young athletes. METHODS: The subjects underwent to an assessment of body composition and they completed two questionnaires, one concerning the level of physical activity and the other regarding eating habits. RESULTS: One hundred fifty-two young athletes (63 females and 89 males) aged 8 to 18 years (13.4±2.5 years, height 159±14 cm) were enrolled in this study. 80.3% of subjects were normal weight (13.4±2.6 years) and 19.7% subjects (13.5±2.5 years) were overweight or obese. Greater sedentary behaviors were found in the overweight or obese participants compared to normal weight (618±125 vs. 523±89 min; P<0.001) and a lower consumption of milk and yoghurt (5.0±3.2 vs. 6.9±4.1 times/week; P=0.031). CONCLUSIONS: Although competitive sports often increase physical activity levels in young people, this activity does not seem to reach the daily recommended amount of physical activity during youth. Therefore, it is necessary to have a comprehensive approach to create a primary prevention strategy from even a young age.

Preliminary Results of an Exercise Program After Laparoscopic Resective Colorectal Cancer Surgery in Non-Metastatic Adenocarcinoma: A Pilot Study of a Randomized Control Trial.

Performing physical exercise after a colorectal cancer diagnosis is associated with lower mortality related to the tumor itself. In order to improve physical recovery after elective surgery, there are no specific exercise protocols after discharge from the hospital. The purpose of this study is to show the preliminary results of an exercise program after colorectal cancer surgery. Six patients with non-metastatic colorectal adenocarcinoma addressed to respective laparoscopic were randomly assigned to a mixed supervised/home-based exercise program for six months and compared to a control group without exercise. To assess the effectiveness of the program, functional and body composition parameters were evaluated. Three months after surgery, the exercise group increased flexibility (p < 0.01, ES = 0.33), strength of lower limbs (p < 0.01, ES = 0.42) and aerobic capacity (p < 0.01, ES = 0.28). After surgery, the six patients experienced a significant reduction in body mass index (BMI) and free fat mass. More specifically, fat mass reached the lowest values, with a concomitant increase in cell mass after six months (p < 0.01, ES = 0.33). This did not occur in the control group. Colorectal cancer treatment induces a reduction in physical function, particularly during the first six months after treatment. A mixed exercise approach appears promising in countering this process after colorectal cancer surgery.

Blood pressure and fasting glucose changes in male migrants waiting for an asylum decision in Italy. A pilot study.

BACKGROUND: The Central Mediterranean route from Libya to Italy has been for years the major port of entry from Africa to Europe. However, information on the early effects of permanence in Italy on cardiovascular risk factors is limited. Therefore, the association between length of stay in Italy and blood pressure or blood glucose was explored in young asylum seekers. METHODS: Cross-sectional study performed on male asylum seekers (aged 18-40 years), hosted for 0-30 months in Prato, Italy. Blood pressure and blood glucose, measured with validated instruments, were classified according to European Society of Hypertension and American Diabetes Association guidelines respectively. The relationship of quartiles of months of stay in Italy (independent variable) with blood pressure and fasting glucose was investigated with multivariate linear regression adjusted for years of age, world area of origin, education level, travel duration in months, smoking habit, alcohol use, body mass index, triglycerides. RESULTS: On average, the 217 asylum seekers lived in Italy for 8.4 months (95% CI 7.5-9.3; range 0-30 months). At multivariate adjusted linear regression analysis, quartiles of months in Italy were associated with a forward shift in the blood pressure categories of the European Society of Hypertension (B = 0.396; 95% CI 0.190 to 0.602) and in the categories fasting glucose levels of the American Diabetes Association (B = 0.450; 95% CI 0.023 to 0.876). CONCLUSIONS: When considering the importance of high blood pressure and type 2 diabetes for ethnic minorities living in Europe, changes of cardiovascular risk factors in the new environment probably need more attention.

Adjuvant Therapy Reduces Fat Mass Loss during Exercise Prescription in Breast Cancer Survivors.

Improvements in cancer care over the years have increased the numbers of cancer survivors. Therefore, quality of life, fat mass management and physical activity are growing areas of interest in these people. After the surgical removal of a breast cancer, adjuvant therapy remains anyway a common strategy. The aim of this study was to assess how adjuvant therapy can affect the effectiveness of an unsupervised exercise program. Forty-two women were enrolled (52.0 ± 10.1 years). Assessments performed at baseline and after six months of exercise prescription were body composition, health-related quality of life, aerobic capacity by Six-Minute Walk Test, limbs strength by hand grip and chair test and flexibility by sit and reach. Statistical analyses were conducted by ANOVA tests and multiple regression. Improvements in body composition, physical fitness and quality of life (physical functioning, general health, social functioning and mental health items) were found. The percentage change in fat mass has been associated with adjuvant cancer therapy (intercept = -0.016; b = 8.629; p < 0.05). An unsupervised exercise prescription program improves body composition, physical fitness and health-related quality of life in breast cancer survivors. Adjuvant therapy in cancer slows down the effectiveness of an exercise program in the loss of fat mass.

Breast cancer: effectiveness of a one-year unsupervised exercise program.

BACKGROUND: Improvements in prevention and therapeutic strategies over the years have considerably increased the number of breast cancer survivors. Sedentary behavior is now acknowledged to be a risk factor for cancer and cancer relapse. Currently, there are different approaches to increasing the effectiveness of long-term physical activity in these patients. The aim of this study was to verify the long-term effectiveness of a home-based program for active lifestyle change in overweight breast cancer survivors. METHODS: We enrolled 43 women (age 51.5±9.9 years), who underwent an evaluation of their spontaneous physical activity levels, their baseline aerobic capacity through a 6-Minute Walking Test (6MWT), their flexibility, grip and lower limb strength, and their body composition. We repeated the measurements of these physical and anthropometric parameters six times during one year of unsupervised exercise. RESULTS: At the beginning of the program the sample showed a moderate level of spontaneous physical activity (physical activity level=1.44±0.12, steps/day=7420.3±1622.3). After being prescribed an individual exercise program, a significant reduction in BMI (T0=27.9±4.3, T5=25.8±3.0 kg/m2; P<0.001) and skinfold sum was observed (T0=99.5±25.2, T5=86.2±22.7 mm; P=0.019), with a parallel maintenance of cell mass (T0= 21.4±3.3, T5= 22.5±3.0 kg; P=0.654). The functional parameters showed an increase in lower limb muscle fitness and a reduction in diastolic blood pressure after 6 MWT (T0= 78.4±10.1, T5= 72.5±14.9 mmhg; P=0.032). CONCLUSIONS: Physical activity is recommended for cancer patients; this model of prescribing unsupervised exercise seems to ensure optimal compliance, thus allowing long-term therapeutic efficacy.

Effects of a home-based exercise rehabilitation program for cancer survivors.

BACKGROUND: Aerobic and resistance exercises have been promoted recently to improve quality of life in cancer patients. Most cancer survivorship rehabilitation programs consist of supervised exercise programs; however, less data is available on the effects of unsupervised or home-based exercise interventions. The study aimed to compare the physical and physiologic changes in a group of cancer survivors (CS) and a control group of non-cancer, health controls (HC) who participated in individualized home-based aerobic and resistance exercises for 12 months. METHODS: Thirty-three surviving cancer survivors (CS) aged 55.6±3 years were enrolled for 1 year of unsupervised exercise prescription programs. Anthropometric parameters hydration status, fitness, and echocardiographic examination were measured every six month and compared to10 HC (aged 52.6±7.7 years) individuals prior to starting the program (t0) and at 6 (t6) and 12 (t12) months. RESULTS: Among the CS subjects, a significant reductions in waist circumference (t0: 97.5±15.2 cm, t6: 86.6±13.5 cm, t12: 85.8±13.9 cm; P<0.05), body cell mass (t0: 50.9±4.7%, t6: 52.3±4.4%, t12: 53.7±3.7%; P<0.05), and extracellular mass (t0: 49.1±4.7%, t6: 47.6±4.4%, t12: 46.2±3.7%; P<0.05) were observed, as well significant improvements in lower body muscle strength (chair test t0: 13.3±4.1, t6: 14.2±3.5, t12: 15.1±3.2; P<0.05). Changes in functionality and heart function were similar between CS and HC. CONCLUSIONS: Individually-prescribed home-based exercise programs were cost effective, safe and resulted in modest improvements in body composition, strength, and total body water distribution with little to no adverse effect on cardiac function.

Exercise and Cancer Survivors: Lessons Learned from a Multi-Faceted Model for Exercise Prescription.

Cancer is the second leading cause of death, and the most common diagnosis among the general population is breast and colon cancer. Recently, an increasing number of new cases of invasive breast and colon cancer have been estimated, and more people die from these diseases. In addition to the genetic pattern, diet and lifestyle including smoking, alcohol consumption, and sedentary behaviour have also been identified as potential risks factors. Recent studies of cancer survivors have shown the beneficial effects of regular physical activity to reduce the prevalence of comorbidity, muscle atrophy, weight changes, reduced aerobic capacity, fatigue, depression, and reduced quality of life. Dedicated and individual programs are crucial for achieving the goals of improving quality of life and reducing comorbidities. A multidisciplinary approach is fundamental: lifestyle assessment, including estimating the level of physical activity, as well as nutritional habits, may be the first step. A periodic cardiovascular examination is crucial for detecting asymptomatic early myocardial failure. According to current ACSM guidelines, different levels of exercise (low-moderate 40% and moderate up to 60% of the maximal HR) may be prescribed, and patients enrolled may follow the exercise program if in the absence of contraindications. The current paper reports observations from our clinical practice and provides practical strategies that bridge contemporary, published guidelines into practice within a multi-disciplinary team working with cancer survivors in Italy.

2D longitudinal LV speckle tracking strain pattern in breast cancer survivors: sports activity vs exercise as prescription model.

Prevention strategies are important to optimize and to manage heart care in breast cancer survivors. Regular physical activity at moderate intensity is normally proposed to maintain myocardial performance; however, no data is available about the different impact of different levels of physical exercise. 2D speckle tracking echocardiography (2DSTE) is an accepted method for early detection of myocardial dysfunction. The study aims to monitor the cardiac performances in breast cancer survivors by 2DSTE analysis to manage sports activity vs physical activity. Two groups of previous breast cancer survivors (33 BCS) trained at moderate intensity and 55 athletes practicing dragon boat (DBA) sport were enrolled. They were matched with two healthy subjects groups: 23 competitive female athletes practicing different sports and 20 healthy women trained with exercise as prescription model. All women were studied by a complete echo examination including LV global longitudinal strain (GLS) assessment (XStrain-Esaote). EF and GS are only significantly higher in healthy subjects (-25.4 ± 2.1). Nevertheless, GLS values are within the normal range for all groups. Particularly, GS does not show any significant differences among subjects (-19.93 ± 4) practicing exercise as prescription when compared to the DBA competitive trained group. 2DSTE method is an appropriate method to supervise the intensity of exercise in breast cancer patients. Particularly, GLS can optimize and improve cancer therapy supporting and creating efficiencies within the health system confirming the role of the exercise prescription therapy in maintaining normal heart function.

Physical Exercise Prescription in Metabolic Chronic Disease.

Metabolic syndrome as a consequence of the association to overweight, hypertension, and diabetes is at high risk of coronary events. Regular physical training has been recently promoted to reduce cardiovascular risks factors, by the improved lifestyle and also by the "anti-inflammatory effectiveness." A positive impact has been shown in case of cancer survived patients either with or without comorbidities and especially in those subjects where the inflammatory process is globally represented. The American College of Sports Medicine (ACSM) guidelines and more recently a new Italian model both support the role of "exercise as therapy" at moderate level of energy expenditure. The importance to establish the individual level of physical exercise, like a drug's dose, has induced authors in investigating this aspect in diverse diseases and in different clinical fields associated to an incorrect lifestyle habits. To reach this goal, a specific research strategy is important to spread the knowledge.

SAFE trial: an ongoing randomized clinical study to assess the role of cardiotoxicity prevention in breast cancer patients treated with anthracyclines with or without trastuzumab.

Over the years, thanks to the addition of new generation systemic agents, as well as the use of more advanced and precise radiotherapy techniques, it was able to obtain a high curability rate for breast cancer. Anthracyclines play a key role in the treatment of breast disease, with a well-known benefit on disease-free survival of patients with positive nodal status. Trastuzumab have shown a significant outcome advantage after 1-year administration in case of HER2-positive disease. Unfortunately, significant increase in cardiotoxicity has been observed after anthracyclines and trastuzumab therapies. Even though the cardiology and oncology community strongly recommend a cardiotoxicity prevention strategy for this subset of patients, there is still no consensus on the optimal patient's approach. We aimed to review the published and ongoing researches on cardioprevention strategies and to present the SAFE trial (CT registry ID: NCT2236806; EudraCT number: 2015-000914-23). It is a randomized phase 3, four-arm, single-blind, placebo-controlled study that aims to evaluate the effect of bisoprolol, ramipril or both drugs, compared to placebo, on subclinical heart damage evaluated by speckle tracking cardiac ultrasound in non-metastatic breast cancer patients.

New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey.

BACKGROUND: Chinese people are one of the fastest growing immigrant populations in Europe, and their health has become a key issue to host nations. Although type 2 diabetes (T2DM) is a big burden among migrant populations, data on Chinese immigrants in Europe are limited. METHODS: A cross-sectional survey was performed in 2014, adopting principles of community-based participatory research to investigate T2DM, diagnosed by the American Diabetes Association fasting criteria, in Chinese first-generation migrants aged 16 to 59 years settled in Prato (Italy). Association with different factors was investigated using logistic regression. RESULTS: Of the 1608 participants, 177 had T2DM (11.0%), 119 being newly diagnosed (7.4%). Among subjects with diabetes, 58 (32.8%) were aware of the disease; among subjects with diabetes aware of their condition, 46 (79%) were treated with glucose lowering drugs. Age-standardized (World Health Organization 2001 population) prevalence of T2DM was 9.6% (95% CI 9.1 to 10.2%), being 12.0% (95% CI 11.0 to 12.9%) in men, and 7.8% (95% CI 7.1 to 8.4%) in women. At adjusted logistic regression, diabetes was associated with hypertension, current smoking, adiposity indices (waist circumference, waist-to-hip ratio, waist-to-height ratio, and body mass index), and high triglycerides. T2DM, adiposity indices, and high triglycerides were not associated with duration of stay in Italy. CONCLUSIONS: The high prevalence of T2DM among first-generation Chinese immigrants in Europe stresses the need for specific health programs for T2DM early diagnosis, treatment, and prevention. There is an urgent need for policies to support this group because current policies will produce major social and economic costs. Copyright © 2016 John Wiley & Sons, Ltd.

Evaluation of physical activity and dietary behaviors in young athletes: a pilot study.

BACKGROUND: The aim of this study was to evaluate the lifestyle based on the physical activity and eating habits of young athletes. METHODS: In order to measure physical activity and eating habits in young people, 922 young athletes between the ages of 8 to 18 have been analyzed in this study. The participants were all patients come to our Department for sport eligibility evaluation; we have asked them to complete an accurate questionnaire in order to assess their personal physical activity levels and their regular eating habits. Parents were invited to sign a letter explaining the aims of the study and were asked for permission on behalf of their child to take part on the study. RESULTS: The eating habits and the physical activity levels of the young athletes observed, resulted improper. We have noticed that the 13.7% of the participants were overweight and obese, despite their practiced sport activity. Physical activity, without sport activity, resulted inadequate in 38.6% of participants: they did not practice regular physical activity. CONCLUSIONS: The results of the study clearly indicate that higher education is therefore necessary in order to promote a healthy lifestyle in terms of both eating habits and physical activity not only in young people, but also in parents and coaches of teams.

Sexual Activity before Sports Competition: A Systematic Review.

Sexual activity before competition has been considered as a possible cause for reduced performance since ancient Greece and Rome. Recently, the hypothesis that optimal sport performance could be influenced by a variety of factors including sexual activity before competition has been investigated. However, few scientific data are available, with the exception of anecdotal reports of individual experiences. The present systematic review focused on the current scientific evidence on the effects of sexual activity on sport performance regardless of sport type. Data were obtained following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, using PubMed/MEDLINE, ISI/Web of Science, the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, ProQuest, and Scopus, all searched from inception further, to broaden the search, no time filter nor language restriction have been applied. Also, the gray literature was mined using Google Scholar. Only relevant scientific articles reporting outcomes of athletic performance after sexual activity were considered. The impact of sexual activity before a sport competition is still unclear, but most studies generally seem to exclude a direct impact of sexual activity on athletic aerobic and strength performance. The most important aspect seems to be the interval from the time of the sports competition that affects negatively the performance if it is shorter than 2 h. There are possible negative effects from some possible concurrent wrong behaviors such as smoking or alcohol abuse. There are no investigations about the effect of masturbation in this context. There is a need to clarify the effects of sexual activity on competition performance. The present evidence suggests that sexual activity the day before competition does not exert any negative impact on performance, even though high-quality, randomized controlled studies are urgently needed.

Lifestyle interventions in preventing new type 2 diabetes in Asian populations.

The aim of this study was to review current evidence on interventional studies aimed at the prevention of type 2 diabetes in Asian population with lifestyle interventions. Prevalence of type 2 diabetes sharply increased in most Asian countries during the last decades. This issue has now also relevant implication for Europe where different surveys are also consistently revealing an higher prevalence of type 2 diabetes and other and major CVD risk factors among subjects originating from Asian Countries than in the native population. Nutrition and lifestyle transition seem to play a role in disclosing the predisposition for the development of type 2 diabetes and great interest is now shown toward the possibility to intervene with lifestyle intervention on at risk populations. A meta-analysis of Randomized Controlled Trials showed that lifestyle interventions are highly effective also in the Asian population. All studies were, however, conducted with an individual approach based on the identification of high-risk individuals. When ethnic minority groups have to be addressed, an approach directed to the community rather than to the individual might, however, be more effective. This review reinforces the importance for policy-makers to consider the involvement of the whole community of minority immigrant groups with lifestyle intervention programs.

Dragon Boat training exerts a positive effect on myocardial function in breast cancer survivors.

INTRODUCTION: Dragon Boat training is often suggested to control upper limb edema in breast cancer (BC) survivors, but little information is available regarding the cardiac impact of such activity. The present study evaluates this aspect during a 4-year follow-up of BC survivors. MATERIAL AND METHODS: From 2006 to 2010, 55 women diagnosed with BC in 2005, treated with adjuvant therapy without evidence of metastases, were enrolled for competitive Dragon Boat training. They underwent ergometric tests yearly, and 2D echocardiography to evaluate hemodynamic, morphological and functional cardiac parameters. RESULTS: The data were compared with those from a group of 36 healthy women (HW). Both groups maintained normal systolic function throughout the period, with Cardiac Mass index, Body Mass Index and Ejection Fraction values being higher in HW. At the onset of the study, the diastolic function of BC survivors was normal though compatible with initial diastolic dysfunction when compared to the diastolic function of HW. After 4 years of competitive activity, the diastolic parameters improved in both groups and particularly in BC survivors (A peak: from 68.5 ± 15.1 cm/s to 50 ± 14.1 cm/s, p < 0.05; Ea: from 9.3 ± 2 cm/s to 11.89 ± 1.7 cm/s, p < 0.001). CONCLUSIONS: BC survivors experienced a significant improvement in diastolic function after 4 years of Dragon Boat training. Dragon Boat training impacts favorably on the myocardial performance in patients previously treated with chemotherapy. These results support the positive role of sport activity in myocardial function of BC survivors.

Exercise as prescription therapy: benefits in cancer and hypertensive patients.

UNLABELLED: PURPOSE Exercise therapy in patients with metabolic chronic disease produces several positive response. This study aims to verify the effects of fast walking associated to a resistance exercise to reduce cardiovascular risk factor. METHODS: Two groups of subjects (10 cancer survivors and 19 hypertensive patients) were evaluated by 6-Minute Walking Test (6MWT), bioimpedance, the Sit & Reach Test (S&R) evaluate the flexibility, Handgrip and 30" Chair Test for muscular strength. Patients were tested before and after 3 months of regular physical exercise. RESULTS: A significant change in anthropometric parameters was observed (BMI: T0 = 29.2±6.8, T3= 27.4±4.4 kg/m2 p<.001; waist circumference: T0=92.5±14.1, T3=92.1±12.8 cm, p<.05) in the hypertensive population. A predominant improvement of the cardiovascular parameters was observed in the cancer survivors (rest DBP T0=76.4±6.5, T3=72.2±7.1 mmhg p<.05; 6MWT: T0=487.8±116.0, T3= 525.6±117.3 m p<.05; S&R: T0= 0.4±7.4, T3=4.1±6.1 cm p<.05). CONCLUSION: A combined aerobic and resistance exercise programme can improve cardiovascular risk factors in hypertensive subjects. The same programme induces improvement in exercise tolerance and flexibility variables in cancer survivors.

Exercise as a prescription therapy for breast and colon cancer survivors.

BACKGROUND: Breast and colon tumors are the most common types of cancer in the general population. As a result of improved diagnosis and treatment, more people are now surviving cancer. Lifestyle has been identified as one of the potential risk factors for cancer, and it has been demonstrated recently that physical activity reduces the physiological and psychological symptoms and side effects of chemotherapy. Muscular atrophy, weight changes, decreased aerobic capacity, fatigue, and depression are the most common symptoms in cancer patients. The exact amount of moderate to vigorous physical activity needed to overcome these effects has not yet been established, but an individualized and variable exercise program as prescription therapy could be considered a helpful tool for improving quality of life. This paper proposes a model of lifestyle analysis and dedicated individualized exercise programs for the treatment of cancer patients. The program starts with a preliminary evaluation of the patient's lifestyle using a questionnaire and accelerometer, which provides information on the amount of daily physical activity and number of steps taken, as well as an assessment of aerobic capacity, cardiovascular response, muscle strength, and resistance. Two different levels of aerobic exercise, ie, low-to-moderate (40% of maximal heart rate) to moderate (60% of maximal heart rate) can be prescribed. This model of exercise prescription in patients with cancer offers a flexible program for assisting in the management of this complex disease. It is projected to ensure easier management of medical problems related to cancer, and to attract a greater number of participants over time.

A case of carcinoid heart metastases.

Carcinoid tumor is an uncommon tumor that has often already developed metastases at the time of diagnosis. The primary site of tumors are the gastrointestinal tract, breast, and bronchus. The first manifestation of "carcinoid syndrome" occurs as a result of hormone production and cardiac involvement can be recognized in approximately half of the patients. The tricuspid or pulmonary valves are often affected, while, more rarely, the myocardial wall is of interest. A 51-year-old female patient affected by a primary pancreatic carcinoid showed interventricular septum carcinoid disease diagnosed by 2D echocardiography.

Sarcoidosis in an athlete.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by "noncaseating granulomas" in different organs. Clinical signs are variable and dependent on the organ involved. Although it is often asymptomatic in athletes, considering the high level of athletic performance and the related risks due to the potential heart involvement, a particular diagnostic flow-chart to consider some other diagnoses is required. The present case report aimed to focus on the clinical approach in case of a progressive weakness associated with a reduction in global performance of an athlete. CASE PRESENTATION: Since October 2008 a 33-year-old Scandinavian professional soccer player has shown splitting headache, fever and impaired exercise tolerance. Despite some clinical aspects and symptoms that could address diagnosis of granulomatosis according to the current guidelines, the first hypothesis was indicative of a possible viral infection. Therefore, the athlete had received a drug-therapy resolving the headache and fever. However, because of the persisting weakness, several other clinical possibilities were evaluated following a more complete diagnostic flow-chart, blood and instrumental exams. CONCLUSION: This case report focuses on the substantial absence of symptoms during the granulomatosis disease, which makes the differential diagnosis to be often complicating. Indeed, several additional exams are required in order to establish the presence of "Non-evolutive sarcoidosis- stage I", for which the therapy is not mandatory.