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.

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.

[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.

[Supporting Patients with Diabetes mellitus type 2 and Obesity in Transfer of Medically Indicated Lifestyle Changes into Everyday Life by a Planning Competence Training in a Randomized Controlled Trial]. / Unterstützung der Lebensstiländerung und Verbesserung der subjektiven Erwerbstätigkeitsprognose bei Patienten mit Diabetes mellitus Typ 2 und Adipositas durch ein Planungskompetenztraining in einem randomisierten Kontrollgruppendesign.

BACKGROUND: Patients with Diabetes mellitus type 2 and/or obesity have difficulties to transfer medically indicated lifestyle changes into everyday life. Hence, this study investigates whether a planning competence training (Planungskompetenztraining, PKT) can support participants of a medical rehabilitation program to foster lifestyle change. METHOD: 467 patients participated in study. Those patients regularly took part in a 3-week program of a rehabilitation clinic between 12/2012 and 08/2014. Using a randomized control group design, training and aftercare effects were controlled (one experimental group [EG] and 3 control groups [KG]. RESULTS: In general, there were no significant differences between the 4 study groups based on an intention-to-treat-analysis. Significant differences were calculated in per-protocol-analysis. Additionally, differences were primarily revealed in a 2 group comparison between participants who participated at training (EG-A and KG-B) vs. those who did not (KG-C und KG-D). CONCLUSION: The implementation of the current training version cannot be recommended for medical rehabilitation. However, in consideration of relevant results a modification of the program could make sense.

[Psychological Measures and BMI-SDS among Adolescents with Obesity and Different Motivational Stages in Inpatient Rehabilitation]. / Psychologische Kennwerte und BMI-SDS bei Jugendlichen mit Adipositas und unterschiedlichen Motivationsstadien in der stationären Rehabilitation.

PURPOSE: Obesity is strongly represented in adolescents, showing a high persistency until adulthood. Previous studies displayed short term effects of inpatient rehabilitation, but failed to demonstrate sustainability. Long-term effects might be expected when taking the motivational stage of adolescents into account. However, there is no evidence regarding motivational stages in obese adolescents in German inpatient rehabilitation. The current study investigated psychological measures and the Body-Mass-Index-standard deviation score (BMI-SDS) in obese adolescents related to motivational stages and age. METHODS: A total sample of n=127 adolescents were included in this cross-sectional study during their inpatient rehabilitation intake. Differences in BMI-SDS and self-reported psychological health were analyzed using 2-way analysis of covariance with the factors motivational stage (intender vs. actor) and age (12-14 vs. 15-17 years), and the covariate gender. Motivational stages were assessed using the newly developed questionnaire to classify motivational stages (Fragebogen zur Einteilung in Motivationsstadien; MoS). RESULTS: Intenders reported unfavorable disease management and volitional parameters. Younger participants reported a lower BMI-SDS as well as lower motivational and volitional parameters. A risk profile emerged for younger intenders which was characterized by psychological problems. CONCLUSION: The results provide important insights for the design of motivational stage-based training programs and underpin the need for age-specific therapies during adolescence.

Increasing physical activity in adult women with Prader-Willi syndrome: A transferability study.

BACKGROUND: The present authors aimed (a) to objectively quantify spontaneous physical activity (PA) in adult patients with Prader-Willi syndrome (PWS) and (b) to evaluate the transferability of a home-based exercise training programme in these patients. METHOD: Physical activity was compared between 10 adult women with PWS (PWS group) and 20 adult women with non-syndromic obesity (CON group, for cross-sectional comparison). In the PWS group, PA, body composition, walking capacity, quality of life and eating behaviour were then compared before and after a 16-week supervised exercise programme. RESULTS: The PWS group displayed lower PA and higher sedentary time compared to the CON group. Median attendance to exercise sessions reached 100% (Q1-Q3: 97%-100%) sessions. Moderate-to-vigorous PA and walking capacity increased after the programme without significant effect on body composition. CONCLUSION: Supervised home-based exercise sessions are an effective strategy to improve PA in women with PWS who are less active than women matched for adiposity.

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.

Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer.

BACKGROUND: Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS: A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS: The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS: HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.

Acute continuous moderate-intensity exercise, but not low-volume high-intensity interval exercise, attenuates postprandial suppression of circulating osteocalcin in young overweight and obese adults.

Bone remodeling markers (BRMs) are suppressed following the consumption of a meal. Our findings indicate that a single session of continuous moderate-intensity exercise, but not low-volume high-intensity interval exercise, performed 1 h after a meal attenuates the postprandial suppression of BRMs. INTRODUCTION: Acute exercise transiently increases BRMs including osteocalcin (tOC) and the undercarboxylated form of osteocalcin (ucOC), a hormone that is implicated in glucose regulation. The effects of acute exercise and exercise-intensity on postprandial levels of tOC and ucOC are unknown. METHODS: Twenty-seven adults that were overweight or obese (age 30 ± 1 years; BMI 30 ± 1 kg∙m-2; mean ± SEM) were randomly allocated to perform a single session of low-volume high-intensity interval exercise (LV-HIIE; nine females, five males) or continuous moderate-intensity exercise (CMIE; eightfemales, five males) 1 h after consumption of a standard breakfast. Serum tOC, ucOC, and ucOC/tOC were measured at baseline, 1 h, and 3 h after breakfast consumption on a rest day (no exercise) and the exercise day (exercise 1 h after breakfast). RESULTS: Compared to baseline, serum tOC and ucOC were suppressed 3 h after breakfast on the rest day (- 10 ± 1% and - 6 ± 2%, respectively; p < 0.05), whereas ucOC/tOC was elevated (2.5 ± 1%; p = 0.08). Compared to the rest day, CMIE attenuated the postprandial-induced suppression of tOC (rest day - 10 ± 2% versus CMIE - 5 ± 2%, p < 0.05) and ucOC (rest day - 6 ± 4% versus CMIE 11 ± 2%, p < 0.05), and increased postprandial ucOC/tOC (rest day 3 ± 2% versus CMIE 15 ± 1%, p < 0.05). In contrast, LV-HIIE did not alter postprandial tOC, ucOC, or ucOC/tOC (all p > 0.1). CONCLUSIONS: Acute CMIE, but not LV-HIIE, attenuates the postprandial-induced suppression of tOC and ucOC. CMIE may be an effective tool to control the circulating levels of BRMs following meal consumption in overweight/obese adults.

Patient Perspectives on Weight Management for Living Kidney Donation.

BACKGROUND: Living kidney donors (LKDs) with obesity have increased perioperative risks and risk of end-stage renal disease after donation. Consequently, obesity serves as a barrier to donation, as many transplant centers encourage or require weight loss before donation for obese LKD candidates. Therefore, this study sought to assess patients' perspectives on weight management strategies before donation among obese LKD candidates. We hypothesized that willingness to participate in a weight loss program may be associated with donor-recipient relationship. MATERIALS AND METHODS: Obese (BMI ≥30 kg/m2) LKD candidates evaluated at a single institution from September 2017 to August 2018 were recruited. A survey was administered to assess LKD candidates' baseline exercise and dietary habits and their interest in weight management strategies for the purpose of donation approval. Participants were grouped by relationship to the recipient (close relatives: first-degree relatives or spouses [n = 29], compared with all other relationships [n = 21]). Descriptive statistics were used to summarize the data. RESULTS: 50 of 51 obese LKD candidates who were approached completed the survey. 90% of participants expressed willingness to lose weight if necessary to become eligible for donor nephrectomy. Compared with all other LKD candidates, close relatives were more likely to be interested in combined diet and exercise programs at our institution (P = 0.01). CONCLUSIONS: Among obese LKD candidates, there was an interest in weight loss for the purposes of living kidney donation approval, particularly among close relatives of potential recipients. Future programs designed to promote weight management efforts for obese LKD candidates should be considered.

Design of an Underwater Treadmill System for rehabilitation of older obese adults: a pre-post study.

BACKGROUND: Patients with knee osteoarthritis (OA) who are obese have problems performing land-based exercises. The reduced joint stress associated with aquatic exercise may benefit these patients. This study aimed to develop an underwater treadmill (UTM) machine that is affordable and suitable for use in developing countries, and to evaluate its efficacy in decreasing pain and increasing functional improvement. METHODS: Clinical testing of the UTM machine was performed in an outpatient setting at Siriraj Hospital during January-June 2017. Patients with knee OA, aged 50-85 years, numerical rating scale (NRS) ≥5/10, and body mass index (BMI) ≥25 kg/m 2 were recruited. The UTM exercise protocol was 30 min/session, 3 days/week, for 4 weeks. The main outcomes were NRS pain score, 6-min walk distance (6MWD), quadriceps strength (QS) and body weight. Those outcomes were evaluated at baseline and at week 4. RESULTS: The UTM was constructed with safety, ergonomically designed and user-friendly control panel with push button for emergency stopping. Thirty patients were included for clinical testing. The mean age was 62.8 years, and almost all were female. The mean BMI was 28.9 kg/m 2. Most patients (65.0%) developed bilateral knee OA, used pain medication (56.7%), and engaged in regular knee exercise (73.3%). Of the 30 enrolled patients, 6 withdrew. All of the remaining 24 patients attended all 12 sessions. The mean difference between baseline and the end of the study was - 2.3 (95% CI: - 3.0, - 1.5; p < 0.001) for NRS pain; 34.9 m (95% CI: 14.1, 55.8; p = 0.002) for 6MWD; and, 1.8 kg (95% CI, 1.1, 2.6; p < 0.001) for QS. Concerning adverse events, 4 patients (15.4%) developed muscle pain, 2 patients (7.7%) had joint pain, and 1 patient (3.9%) withdrew due to severe knee pain. Two-thirds of patients described themselves as being 'very satisfied' with UTM exercise, and approximately 90% of participants rated their symptoms as 'improved' or 'much improved'. CONCLUSIONS: 4-week exercise with UTM can significantly improve NRS pain, 6MWD, and QS. UTM could be an alternative treatment for patients with knee OA who are obese due to small size, durability, and ecofriendly design as an exercise modality.

Effect of a short message service (SMS) intervention on adherence to a physiotherapist-prescribed home exercise program for people with knee osteoarthritis and obesity: protocol for the ADHERE randomised controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a highly prevalent condition. People with knee OA often have other co-morbidities such as obesity. Exercise is advocated in all clinical guidelines for the management of knee OA. It is often undertaken as a home-based program, initially prescribed by a physiotherapist or other qualified health care provider. However, adherence to home-based exercise is often poor, limiting its ability to meaningfully change clinical symptoms of pain and/or physical function. While the efficacy of short message services (SMS) to promote adherence to a range of health behaviours has been demonstrated, its ability to promote home exercise adherence in people with knee OA has not been specifically evaluated. Hence, this trial is investigating whether the addition of an SMS intervention to support adherence to prescribed home-based exercise is more effective than no SMS on self-reported measures of exercise adherence. METHODS: We are conducting a two-arm parallel-design, assessor-and participant-blinded randomised controlled trial (ADHERE) in people with knee OA and obesity. The trial is enrolling participants exiting from another randomised controlled trial, the TARGET trial, where participants are prescribed a 12-week home-based exercise program (either weight bearing functional exercise or non-weight bearing quadriceps strengthening exercise) for their knee by a physiotherapist and seen five times over the 12 weeks for monitoring and supervision. Following completion of outcome measures for the TARGET trial, participants are immediately enrolled into the ADHERE trial. Participants are asked to continue their prescribed home exercise program unsupervised three times a week for 24-weeks and are randomly allocated to receive a behaviour change theory-informed SMS intervention to support home exercise adherence or to have no SMS intervention. Outcomes are measured at baseline and 24-weeks. Primary outcomes are self-reported adherence measures. Secondary outcomes include self-reported measures of knee pain, physical function, quality-of-life, physical activity, self-efficacy, kinesiophobia, pain catastrophising, participant-perceived global change and an additional adherence measure. DISCUSSION: Findings will provide new information into the potential of SMS to improve longer-term exercise adherence and ultimately enhance exercise outcomes in knee OA. TRIAL REGISTRATION: Prospectively registered with the Australian New Zealand Clinical Trials Registry. Reference: ACTR N12617001243303 Date/version: August 2019/two.

Effect of aerobic exercise, low-fat and high-fat diet on the testis tissue and sperm parameters in obese and nonobese mice model.

Semen quality and male fertility depend on numerous factors such as age, environment, lifestyle, physical activity, genetic background and occupation. We aimed to access the effect of aerobic exercise, low- and high-fat diet on mice testis tissue, and sperm function. Obese and nonobese male mice C57BL/6 were exposed to high fat (Hf) or low fat (Lf) and/or activity (Exe: exercise or Sed: sedentary). Finally, testicular morphometric characteristics, sperm concentration and motility (light microscopy), sperm morphology (eosin/nigrosin dye), lipid peroxidation (BODIPY C11 Probe), chromatin (acridine orange and chromomycin A3 staining) were compared within obese groups (Hf/Exe, Lf/Exe, Lf/Sed, Hf/Sed) and nonobese groups (Hf/Exe, Lf/Exe, Lf/Sed, Hf/Sed). Both exercise and diet interventions did not show any alteration in testicular morphological characteristics, sperm morphology and DNA fragmentation within both obese and nonobese groups (p > 0.05). Exercise and/or diet resulted in a significant increase in sperm concentration and motility within both groups (p < 0.05). Exercise in both groups leads to high percentage of lipid peroxidation (p < 0.05). Exercise intervention significantly improved sperm protamine deficiency within obese group (p < 0.05). We concluded that exercise intervention was more effective than diet in improvement of sperm function within obese groups.

The effect of newly initiated exercise training on dynamic thiol / disulphide homeostasis in sedentary obese adults.

We studied dynamic thiol/disulphide homeostasis, an indicator of oxidative stress, to investigate the effects of newly initiated exercise training on sedentary obese adults. Seventeen sedentary obese adults and 15 normal-weight controls were included in the sample for this study. The obese adults were given a physical exercise training program that lasted twelve weeks. Before and after the exercise training program, blood samples were collected, and serum thiol/disulphide parameters were measured by using a novel technique. Before the start of the exercise training, it was observed that thiol/disulphide homeostasis was impaired, and this impairment was positively correlated with body mass index in sedentary obese adults because of the higher reactive oxygen species production in adipose tissue. However, while the obese participants' body mass index significantly decreased, the thiol/disulphide homeostasis parameters in the obese adults did not change over time as calculated at the baseline and compared to the calculation after the twelve weeks of exercise training. Despite a decrease in body mass index that occurred after the twelve weeks of exercise training, there was a lack of improvement in the obesity-induced impairment of thiol/disulphide homeostasis, which suggests that a newly initiated exercise training program may lead to oxidative stress.

Autonomic responses induced by aerobic submaximal exercise in obese and overweight adolescents.

BACKGROUND: Graded exercises tests are performed in adult populations; nonetheless, the use of this type of assessment is greatly understudied in overweight and obese adolescents. OBJECTIVE: To investigate heart rate autonomic responses to submaximal aerobic exercise in obese and overweight adolescents. METHODS: We recruited 40 adolescents divided into two groups: (1) overweight group comprising 10 boys and 10 girls between Z-score +1 and +2 and (2) obese group comprising 10 boys and 10 girls above Z-score >+2. Heart rate variability was analysed before (T1) and after exercise (T2-T4) on treadmill at a slope of 0%, with 70% of the maximal estimated heart rate (220 - age) for 20 minutes. RESULTS: Heart rate in the overweight group was: 93.2±10.52 bpm versus 120.8±13.49 bpm versus 94.6±11.65 bpm versus 93.0±9.23 bpm, and in the obese group was: 92.0±15.41 bpm versus 117.6±16.31 bpm versus 92.1±12.9 bpm versus 91.8±14.33 bpm. High frequency in the overweight group was: 640±633.1 ms2 versus 84±174.66 ms2 versus 603.5±655.31 ms2 versus 762.6±807.21 ms2, and in the obese group was: 628.4±779.81 ms2 versus 65.4±119.34 ms2 versus 506.2±482.70 ms2 versus 677.9±939.05 ms2; and root mean square of successive differences in the overweight group was: 37.9±18.81 ms versus 10.9±8.41 ms versus 32.8±24.07 ms versus 36.7±21.86 ms, and in the obese group was: 38.7±23.17 ms versus 11.5±8.62 ms versus 32.3±16.74 ms versus 37.3±24.21 ms. These values significantly changed during exercise compared with resting values in overweight and obese groups. Moreover, we also reported no significant difference of resting parasympathetic control of heart rate between obese and overweight adolescents. CONCLUSION: There was no significant difference of autonomic responses elicited by submaximal aerobic exercise between overweight and obese adolescents.

[Aftercare Following Inpatient Rehabilitation of Patients with Obesity: Feasibility of the KgAS-Concept]. / Ambulante Nachsorge nach stationärer Adipositasrehabilitation: Machbarkeit des KgAS-Nachsorgekonzeptes.

Even though the inpatient rehabilitation of children and adolescents with obesity shows beneficial effects in short term, the relapse rate afterwards is high. Previous attempts to implement successful aftercare programs that are open to all patients were either not successful or have been cancelled. Therefore, a new program was developed and evaluated in terms of feasibility. In a cooperation of a rehabilitation clinic with aftercare specialists, 25 families were enabled to participate. During the inpatient treatment a case management was established to accompany and transfer the patients to the ambulatory care afterwards. The process and the aftercare were evaluated by questionnaires (children/adolescents, parents, aftercare specialists) as well as one-on-one interviews and a focus group with the aftercare specialists that were also analyzed. Results show the feasibility of the program and good satisfaction rates among all participating groups (children/adolescents, parents, aftercare specialists, inpatient rehabilitation center). Thus, the program might be eligible in the treatment process. However, the evaluation of the effectiveness in a randomized controlled study is recommended.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese.

PURPOSE: The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese. METHODS: This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions. RESULTS: Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes. CONCLUSIONS: Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

High-intensity interval training induced PGC-1∝ and AdipoR1 gene expressions and improved insulin sensitivity in obese individuals.

INTRODUCTION: High-intensity interval training (HIIT) has been found to improve cardiometabolic health outcome as compared to moderate-intensity continuous exercise. However, there is still limited data on the benefits of HIIT on the expression of regulatory proteins that are linked to skeletal muscle metabolism and insulin sensitivity in obese adults. This study investigated the effects of HIIT intervention on expressions of peroxisome proliferatoractivated receptor-γ coactivator 1-∝ (PGC-1∝) and adiponectin receptor-1 (AdipoR1), insulin sensitivity (HOMAIR index), and body composition in overweight/obese individuals. METHODS: Fifty overweight/obese individuals aged 22-29 years were assigned to either no-exercise control (n=25) or HIIT (n=25) group. The HIIT group underwent a 12-week intervention, three days/week, with intensity of 65-80% of age-based maximum heart rate. Anthropometric measurements, homeostatic model of insulin resistance (HOMA-IR) and gene expression analysis were conducted at baseline and post intervention. RESULTS: Significant time-by-group interactions (p<0.001) were found for body weight, BMI, waist circumference and body fat percentage. The HIIT group had lower body weight (2.3%, p<0.001), BMI (2.7%, p<0.001), waist circumference (2.4%, p<0.001) and body fat percentage (4.3%, p<0.001) post intervention. Compared to baseline, expressions of PGC-1∝ and AdipoR1 were increased by approximately three-fold (p=0.019) and two-fold (p=0.003) respectively, along with improved insulin sensitivity (33%, p=0.019) in the HIIT group. CONCLUSION: Findings suggest that HIIT possibly improved insulin sensitivity through modulation of PGC-1∝ and AdipoR1. This study also showed that improved metabolic responses can occur despite modest reduction in body weight in overweight/obese individuals undergoing HIIT intervention.

Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial.

BACKGROUND: Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors. METHODS: One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65-85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis. RESULTS: At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO2max (p < 0.001), muscular strength (p < 0.001), osteocalcin (p = 0.01), and BSAP (p = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (p < 0.01). CONCLUSIONS: A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.