Co-construct, implement and evaluate a multi-level intervention to prevent a sedentary lifestyle in children-Study protocol of the CIPRES study.

BACKGROUND: A sedentary lifestyle is commonly associated with a higher risk of chronic disease development. Among school-aged children from European countries, screen-time represents a significant portion of sedentary time with 39.8% of children spending more than 2h/day in front of a screen on average. Therefore, effective solutions to reduce sedentary behavior (SB) must be found. Multilevel interventions based on the socio-ecological model (SEM) are particularly relevant to take into account influences of the social environment on individuals' SB. Moreover, the trans-contextual model (TCM) can offer complementary levers for individuals' behavior change. The CIPRES study is a theory-based multilevel intervention designed to decrease the SB in French primary school children aged 8-10 years. The present paper describes the protocol of a randomized controlled study to evaluate the effectiveness of the CIPRES multilevel intervention on SB. METHODS: The CIPRES study is a cluster-randomized controlled trial comparing intervention vs control groups. A total of 700 children are targeted for inclusion, distributed in four municipalities considered as clusters. The study consists of two successive phases: 1) co-building of a SB prevention intervention by using a participatory approach involving representatives of each level of the SEM (e.g., children, parents, staff from municipalities, teachers) and 2) implementation and evaluation of the intervention. The intervention will last for 6 weeks in each involved class. Primary outcome will be the sedentary time of children per week, assessed by accelerometry. In addition, children and their parents will be asked to fill out questionnaires concerning children's physical activity level, screen time, quality-of-life and variables of the TCM. DISCUSSION: This study will give information on the effectiveness of a theory-based intervention, involving multiple levels of actors in the co-construction and the implementation of the intervention, that may interest schools and public health officers looking for innovative sedentary prevention programs.

Comparison of dance and aerobic exercise on cognition and neuropsychiatric symptoms in sedentary older adults with cognitive impairment.

BACKGROUND: To compare the effects of dance and aerobic exercise on cognition and neuropsychiatric symptoms in older people with cognitive impairment. METHODS: Twenty-three older adults (mean age = 78 ± 7 years; males: n = 7, females: n = 16) attending a day care center and diagnosed with cognitive impairment were randomly assigned to a 16-week dance intervention or an aerobic exercise intervention (60 min/week). Cognitive function [Mini-Mental State Examination (MMSE)], neuropsychiatric symptoms [Geriatric Depression Scale-15 (GDS-15), Neuro-Psychiatric Inventory-R (NPI-R)], and physical function [Timed Up and Go (TUG), Activity Daily Living (ADL)] were assessed at baseline and at the end of the intervention. After Borg scale assessment, these two physical activities were performed at similar intensity (60-70% HRR). RESULTS: MMSE score increased significantly after the intervention in the dance group (+ 3.3/+ 14%, p = 0.03), especially memory performance (+1/+220%, p = 0.03), but not in the aerobic exercise group. GDS-15 and NPI-R decreased significantly after the intervention in both groups (p < 0.001). However, no significant effect was found for TUG and ADL. CONCLUSION: Dance is a cost-effective multimodal intervention that could improve cognition. A low-frequency ecological dance intervention (once per week; 60 min) could improve cognition, especially verbal memory. These results should be further investigated for the practice of dance in facilities for older adults.

A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia.

PURPOSE: To investigate which type, frequency, duration, intensity, and volume of chronic exercise might more strongly reduce pro-inflammatory cytokines and enhance anti-inflammatory cytokines in human and animal models with Mild Cognitive Impairment (MCI) or dementia. DESIGN: A systematic review. DATA SOURCE: English-language search of 13 electronic databases: Web of Science, PubMed/Medline, Sport Discus, Scopus, Cochrane, Psych Net, Springer, ScienceDirect, Pascal & Francis, Sage journals, Pedro, Google Scholar, and Sage. INCLUSION CRITERIA: (i) human and animal studies that included exercise, physical activity, or fitness training as an experimental intervention, (ii) studies that addressed MCI, dementia, or AD, (iii) studies that focused on measuring cytokines and/or other inflammatory and/or neuroinflammatory immune markers, (iii) studies that examined inflammatory indicators in blood, CSF (Cerebrospinal Fluid), and brain tissue. RESULTS: Of the 1290 human and animal studies found, 38 were included for qualitative analysis, 11 human articles, 25 animal articles, and two articles addressing both human and animal protocols. In the animal model, physical exercise decreased pro-inflammatory markers in 70.8 % of the articles and anti-inflammatory cytokines: IL -4, IL -10, IL-4ß, IL -10ß, and TGF-ß in 26 % of articles. Treadmill running, resistance exercise, and swimming exercise reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines. In the human model, 53.9 % of items reduced pro-inflammatory proteins and 23 % increased anti-inflammatory proteins. Cycling exercise, multimodal, and resistance training effectively decreased pro-inflammatory cytokines. CONCLUSION: In rodent animal models with AD phenotype, treadmill, swimming, and resistance training remain good interventions that can delay various mechanisms of dementia progression. In the human model, aerobic, multimodal, and resistance training are beneficial in both MCI and AD. Multimodal training of moderate to high intensity multimodal exercise is effective for MCI. Voluntary cycling training, moderate- or high-intensity aerobic exercise is effective in mild AD patients.

A Comparison of an Alternative Weight-Grading Model Against Chronological Age Group Model for the Grouping of Schoolboy Male Rugby Players.

OBJECTIVES: Concerns regarding marked differences in the weights and body composition of young rugby players competing within the same age groups have led to the suggestion of alternative models for grouping young players. The aims of this study were (1) to compare variance in the body size and body composition of schoolboy rugby players (9 to 14 years), across weight- and age-grading models, and (2) to identify morphotypes for the weight model using Hattori's body composition chart. MATERIALS AND METHODS: Skinfold thickness measurements were used to assess body fat mass (BF), fat-free mass (FFM), body fat mass index (BFMI), and fat-free mass index (FFMI). Standardized measure of height and weight were taken for all participants. Data were grouped according to the age categories of the French Rugby Federation (U11: Under 11 years, U13: Under 13 years, and U15: Under 15 years), and to the weight categories (W30-44.9; W45-59.9; and W60-79.9) carried out from 25th and 75th weight percentile in each age category. Body mass index status (NW normal-weight versus OW/OB overweight/obese) was considered. Extreme morphotypes are characterized from BFMI and FFMI in the weight-grading model on Hattori's body composition chart. RESULTS: The dispersion of anthropometric characteristics decreased significantly for the weight model, except for height in all groups and BFMI for U13. Among NW, 3, 1.8, and 0% upgraded; 18.2, 68.7, and 45.5% downgraded; among OW, 50, 21.5, and 12.5%; and among OB, 91.3, 83.3, and 74.6% upgraded, respectively, in U11, U13, U15. FFMI/BFMI were correlated in U11 (r = 0.80, p < 0.001), U13 (r = 0.66, p < 0.001), and U15 (r = 0.77, p < 0.001). There was no significant correlation in W45-59.9 and low correlations in W30-44.9 (r = 0.25, p < 0.001) and W60-79.9 (r = 0.29, p < 0.001). Significant grading difference between the centroids (p < 0.05) and the distribution deviates from centroids of BFMI and FFMI (p < 0.0001) were noted between the two models. Thirteen players were located in adipo-slender, twenty-three in adipo-solid, twenty-two in lean-slender, and two located in the lean-solid morphotype in weight model. CONCLUSION: A weight-grading model should be considered to limit mismatches in anthropometric variables. However, variations of body composition also persisted for this model. Hattori's body composition chart allowed more detailed examination of morphological atypicalities among schoolboy rugby players.

Hyperoxia During Exercise: Impact on Adenosine Plasma Levels and Hemodynamic Data.

INTRODUCTION: Adenosine is an ATP derivative that is strongly implicated in the cardiovascular adaptive response to exercise. In this study, we hypothesized that during exercise the hyperemia, commonly observed during exercise in air, was counteracted by the downregulation of the adenosinergic pathway during hyperoxic exposure. METHODS: Ten healthy volunteers performed two randomized sessions including gas exposure (Medical air or Oxygen) at rest and during exercise performed at 40% of maximal intensity, according to the individual fitness of the volunteers. Investigations included the measurement of adenosine plasma level (APL) and the recording of hemodynamic data [i.e., cardiac output (CO) and systemic vascular resistances (SVR) using pulsed Doppler and echocardiography]. RESULTS: Hyperoxia significantly decreased APL (from 0.58 ± 0.06 to 0.21 ± 0.05 µmol L-1, p < 0.001) heart rate and CO and increased SVR in healthy volunteers at rest. During exercise, an increase in APL was recorded in the two sessions when compared with measurements at rest (+0.4 ± 0.4 vs. +0.3 ± 0.2 µmol L-1 for medical air and oxygen exposures, respectively). APL was lower during the exercise performed under hyperoxia when compared with medical air exposure (0.5 ± 0.06 vs. 1.03 ± 0.2 µmol L-1, respectively p < 0.001). This result could contribute to the hemodynamic differences between the two conditions, such as the increase in SVR and the decrease in both heart rate and CO when exercises were performed during oxygen exposure as compared to medical air. CONCLUSION: Hyperoxia decreased APLs in healthy volunteers at rest but did not eliminate the increase in APL and the decrease in SVR during low intensity exercise.

A Cross-Sectional Study Assessing the Contributions of Body Fat Mass and Fat-Free Mass to Body Mass Index Scores in Male Youth Rugby Players.

BACKGROUND: In some sports such as rugby, a large body size is an advantage, and the desire to gain weight can bring young players to become overweight or obese. The aim of this study was to evaluate the prevalence of overweight and obesity and the contribution of body fat mass index (BFMI) and fat-free mass index (FFMI) to body mass index (BMI) changes among young male rugby players (15-a-side rugby). METHODS: The criteria of the International Obesity Task Force were used to define overweight and obesity from BMI. The method of skinfold thickness was used to assess percentage of body fat (%BF), BFMI, and FFMI. Excess body fat was defined by using BFMI and %BF above the 75th percentile. Data were grouped according to the age categories of the French Rugby Federation (U11, under 11 years; U13, under 13 years; U15, under 15 years) and to BMI status (NW normal-weight versus OW/OB overweight/obese). RESULTS: Overall, 32.8% of the young players were overweight, and 13.8% were obese. However, 53% of young players classified as obese and overweight by BMI had an excess body fat by using BFMI above the 75th percentile. FFMI increased significantly between U11 and U13 in both groups, without significant change in BMI and BFMI. Both groups had similar significant gains in BMI and FFMI between U13 and U15, while BFMI only increased significantly in OW/OB (+ 18.5%). The strong correlations between BMI and %BF were systematically lower than those between BMI and BFMI. FFMI was strongly or moderately associated with BFMI. CONCLUSIONS: Chart analysis of BFMI and FFMI could be used to distinguish changes in body composition across age categories in young male rugby players classified as normal-weight, overweight, and obese by BMI.

Heart rate recovery improves after exercise in water when compared with on land.

BACKGROUND: Water immersion has demonstrated its effectiveness in the recovery process after exercise. This study presents for the first time the impact of water immersion on heart rate recovery after low-intensity cycle exercise. METHODS: Sixteen male volunteers were involved in the study. The experiment consisted of two cycling exercises: 1 h in ambient air and 1 h in water (temperature: 32 ± 0·2°C). The exercise intensity was individually prescribed to elicit around 35%-40% of VO2 peak for both conditions. Heart rate recovery was analysed according to recognized methods, such as the differences between heart rate at exercise completion and within the 2 min recovery period. RESULTS: Although the two exercises were performed both at same energy expenditure and heart rate, the indexes used to assess the fast and slow decay of the heart rate recovery were significantly shortened after exercise in water. CONCLUSION: The results of the present study suggest that cycling in thermoneutral water decreases the cardiac work after exercise when compared with cycling on land.

Hyperoxia Improves Hemodynamic Status During Head-up Tilt Testing in Healthy Volunteers: A Randomized Study.

Head-up tilt test is useful for exploring neurally mediated syncope. Adenosine is an ATP derivative implicated in cardiovascular disturbances that occur during head-up tilt test. The aim of the present study was to investigate the impact of hyperoxia on adenosine plasma level and on hemodynamic changes induced by head-up tilt testing.Seventeen healthy male volunteers (mean age 35 ±â€Š11 years) were included in the study. The experiment consisted of 2 head-up tilt tests, 1 session with subjects breathing, through a mask, medical air (FiO2 = 21%) and 1 session with administration of pure oxygen (FiO2 = 100%) in double-blind manner. Investigations included continuous monitoring of hemodynamic data and measurement of plasma adenosine levels.No presyncope or syncope was found in 15 of the 17 volunteers. In these subjects, a slight decrease in systolic blood pressure was recorded during orthostatic stress performed under medical air exposure. In contrast, hyperoxia led to increased systolic blood pressure during orthostatic stress when compared with medical air. Furthermore, mean adenosine plasma levels decreased during hyperoxic exposure before (0.31 ±â€Š0.08 µM) and during head-up tilt test (0.33 ±â€Š0.09 µM) when compared with baseline (0.6 ±â€Š0.1 µM). Adenosine plasma level was unchanged during medical air exposure at rest (0.6 ±â€Š0.1 µM), and slightly decreased during orthostatic stress. In 2 volunteers, the head-up tilt test induced a loss of consciousness when breathing air. In these subjects, adenosine plasma level increased during orthostatic stress. In contrast, during hyperoxic exposure, the head-up tilt test did not induce presyncope or syncope. In these 2 volunteers, biological study demonstrated a decrease in adenosine plasma level at both baseline and during orthostatic stress for hyperoxic exposure compared with medical air.These results suggest that hyperoxia was able to increase blood pressure during head-up tilt test via a decrease in plasma adenosine concentration. Our results also suggest that adenosine receptor antagonists are worth trying in neurocardiogenic syncope.

Cardiorespiratory alterations induced by low-intensity exercise performed in water or on land.

The aim of this study was to compare the cardiorespiratory alterations induced by a low-intensity exercise performed on land or in water. Sixteen healthy subjects were investigated. The exercise consisted of a 1-h period of ergocycling at 35%-40% of peak oxygen uptake. Investigations were performed at rest and 45 min after the beginning of the exercises. Hemodynamic changes were studied by Doppler-echocardiography. Gas exchanges were continuously monitored by an oxygen gas analyzer. Blood samples were taken successively at baseline, within the last minutes of the exercise bout, and during recovery to measure total protein concentration and natriuretic peptides. Cardiovascular parameters were not significantly different during exercise performed on land or in water. As a result of an accelerated breathing frequency, ventilation output was significantly greater in water. Biological changes included a decrease in total protein concentration and an increase in natriuretic peptides in water. During low-intensity exercise, ventilatory alterations favoured increasing the work of breathing while in the water when compared with the same exercise performed on land. Hemodynamic changes were similar in the 2 conditions. Furthermore, biological findings suggest that the fluid transfer from intravascular sector toward interstitial sector could be facilitated in water.

Severely obese adolescent girls rely earlier on carbohydrates during walking than normal-weight matched girls.

The purpose of this study was to determine the substrate oxidation rate and the exercise intensity at which maximal lipid oxidation and ventilatory threshold (VT) occur in obese (BMI: 36.6 ± 6.3 kg · m(-2)) and normal-weight adolescent girls (BMI: 18.7 ± 1.6 kg · m(-2)) aged 14-18 years. Substrate oxidation rate was determined by gas exchange using an incremental field test involving walking. Body composition was assessed by bioelectrical impedance. Carbohydrate oxidation rates were significantly higher in obese than in normal-weight girls at speeds ranging from 4 to 6 km · h(-1) (P < 0.05), whereas no significant differences were observed between groups regarding lipid oxidation rates. The crossover point of substrate utilisation and the VT were significantly lower in obese than in normal-weight adolescents (P < 0.05). Maximal lipid oxidation rate was observed at 46 ± 15 and 53 ± 15 %EVO2max in obese and normal-weight adolescents, respectively. At these intensities, the Lipox(max) was significantly lower in obese than in normal-weight girls (6.7 ± 2.3 versus 8.9 ± 3.5 mg · min(-1) · kg(-1) FFM, P < 0.05, 95% CI: -3.7 to -0.7, d = -0.74). The present results have implications in designing interventions to promote lipid oxidation and energy expenditure during walking in severely obese adolescent girls.

Glossopharyngeal insufflation and breath-hold diving: the more, the worse?

OBJECTIVE: The glossopharyngeal insufflation maneuver (lung packing) is largely performed by competitive breath-hold divers to improve their performance, despite observational evidence of fainting and loss of consciousness in the first seconds of apnea. METHODS: We describe here the time course of hemodynamic changes, induced by breath-holding with and without lung packing, in 2 world-class apnea competitors. RESULTS: When compared with apnea performed after a deep breath (100% vital capacity), lung packing leads to a decrease in cardiac output, blood pressure, and cerebral blood flow during the first seconds after the beginning of apnea. The major hemodynamic disorders were observed in diver 1, who exhibited the greater increase in pulmonary volume after lung packing (+22% for diver 1 vs +10% for diver 2). After the initial drop in both cardiac output and blood pressure, the time course of hemodynamic alterations became quite similar between the two apneas. CONCLUSIONS: Some recommendations, such as limiting the number of maneuvers and performing lung packing in the supine position, should be expressed to avoid injuries secondary to the use of glossopharyngeal insufflation.

Effect of head-out water immersion on vascular function in healthy subjects.

Immersion in thermoneutral water increases cardiac output and peripheral blood flow and reduces systemic vascular resistance. This study examined the effects of head-out water immersion on vascular function. Twelve healthy middle-aged males were immersed during 60 min in the seated position, with water at the level of xiphoid. Local and central vascular tone regulating systems were studied during that time. Brachial artery diameter and blood flow were recorded using ultrasonography and Doppler. Endothelial function was assessed with flow-mediated dilation. Results were compared with the same investigations performed under reference conditions in ambient air. During water immersion, brachial artery diameter increased (3.7 ± 0.2 mm in ambient air vs. 4 ± 0.2 mm in water immersion; p < 0.05). Endothelium-mediated dilation was significantly lower in water immersion than in ambient air (10% vs. 15%; p = 0.01). Nevertheless, the difference disappeared when the percentage vasodilatation of the brachial artery was normalized to the shear stimulus. Smooth muscle-mediated dilation was similar in the 2 conditions. Spectral analysis of systolic blood pressure variability indicated a decrease in sympathetic vascular activity. Plasma levels of nitric oxide metabolites remained unchanged, whereas levels of natriuretic peptides were significantly elevated. An increase in brachial blood flow, a decrease in sympathetic activity, a warming of the skin, and an increase in natriuretic peptides might be involved in the increase in reference diameter observed during water immersion. Endothelial cell reactivity and smooth muscle function did not appear to be altered.

A 5-month weight-reduction programme has a positive effect on body composition, aerobic fitness, and habitual physical activity of severely obese girls: a pilot evaluation study.

In this pilot study, we wished to determine whether a 5-month multidisciplinary programme of a combined dietary-nutritional education-exercise intervention would have favourable effects on the health status of 18 obese adolescent girls. Before and after the clinical intervention, body composition and habitual physical activity were assessed by bioelectrical impedance and accelerometry, respectively. Aerobic fitness and substrate utilization were determined by gas exchange using an incremental field test that mimics habitual conditions. Despite a significantly (P < 0.001) greater loss of fat mass (-8.7 +/- 4.1 kg) compared with fat-free mass (-2.8 +/- 2.2 kg), energy expenditure at rest decreased by 9% following the intervention. Maximal oxygen consumption [Vdot]O2max related to fat-free mass increased by 7% (P < 0.05), whereas substrate utilization during exercise did not change following the intervention. Moderate and intense physical activity increased by 15% (+20 min . day(-1); P < 0.05) and 45% (+25 min . day(-1); P < 0.01), respectively. A significant relationship was observed between change in habitual physical activity and change in .[Vdot]O2max fat-free mass (r = 0.56, P = 0.01). The present multidisciplinary programme enhanced the loss of fat mass relative to fat-free mass but not sufficiently so to prevent a decline in metabolic rate during rest. Our results suggest a coupling in the improvement of aerobic fitness and habitual physical activity in obese adolescent girls, and hence an improvement in behaviour in relation to physical activity.

Arterial compliance in divers exposed to repeated hyperoxia using rebreather equipment.

BACKGROUND: Acute hyperoxic exposure is known to modify cardiovascular parameters like a decrease in cardiac output, arterial vasoconstriction, and autonomic nervous system changes. We hypothesized that repeated hyperbaric hyperoxic exposures, as experienced by military oxygen divers, lead to long-term arterial alterations. METHODS: Arterial blood pressure measurements and pulse wave velocity (PWV) recordings were performed during basal conditions in 15 elite military oxygen divers, and compared to 15 non-diver controls. The two groups were matched appropriately for physical characteristics (age: 35 +/- 5 yr, weight: 77 +/- 8 kg, height: 177 +/- 6 cm, body mass index: 24.6 +/- 2.0 kg x m(-2)), and aerobic capacity (VO2max : 52 +/- 7 ml x min(-1) x kg(-1)). RESULTS: No significant difference was found in systolic blood pressure (120 +/- 11 mmHg), diastolic blood pressure (70 +/- 8 mmHg), or pulse pressure (50 +/- 7 mmHg). Furthermore, there was no significant difference in the carotid-femoral PWV (6.7 +/- 0.9 m x s(-1)), the carotid-radial PWV (8.7 +/- 1.7 m x s(-1)), or the carotid-pedal PWV (8.1 +/- 1.1 m x s(-1)) between divers and controls. CONCLUSION: No difference in arterial compliance was observed in physically well-trained military oxygen divers in comparison with matched controls.

Muscle performance in patients with Crohn's disease in clinical remission.

BACKGROUND: Because patients with Crohn's disease (CD) often show increased energy expenditure, nutritional deficiencies, and general fatigue, all which may persist after a flare, we hypothesized that CD could alter muscle mass and function. This study aimed to assess muscle strength and endurance in CD patients in clinical remission and the influencing factors. METHODS: Forty-one outpatients (17 men and 24 women; age, 37 +/- 10 yr), in remission (CD Activity Index < 150) for > 3 months, and 25 age-matched healthy controls (10 men and 15 women; age, 37 +/- 13 yr) were evaluated. Evaluation included a sit-up test, hand-grip strength test, hand-grip endurance test, lower limb strength test, and lower limb endurance test (LE), as well as a measure of physical activity. RESULTS: No significant difference was found between CD and control groups regarding weight, height, body mass index, fat mass, and fat-free mass. Strength performance was lower in CD subjects compared with controls, particularly for lower limb indexes: lower limb strength test (-24.6%, P < 0.001), LE (-25.8%, P < 0.001), and sit-up test (-25.1%, P < 0.001). Previous disease severity, disease duration, the cumulative dose of glucocorticosteroids, current inflammation, and global habitual physical activity did not affect muscle performance. A recent use of steroids improved LE. CONCLUSIONS: CD patients in clinical remission have decreased muscle function that may affect their quality of life. This pattern is reflected by reduced strength and endurance indexes, particularly for lower limbs. The reasons for these changes need further study. Strength training should be assessed in these patients.

[Habitual physical activity during growth]. / L'activité physique habituelle au cours du développement.

The three objectives of the present review of the literature were to: characterize the evolution of habitual physical activity (HPA) during growth; evaluate the tracking of HPA from childhood to adulthood; and analyse the level of HPA in children and adolescents according to public health recommendations. Data indicates that HPA decreases from childhood to adulthood about 7% per year, with a great reduction during puberty and adolescence concurrent to changes in the type of physical activity. It appears that HPA is not quite steady (0.09 < r < 0.66) during growth, which means that behavioural changes occur. Being very active during childhood or adolescence does not necessarily translate into a high level of HPA in adulthood. The mean values of HPA of children and adolescents vary from 15 to 90 min.day(-1) between studies, and for most of them HPA has been higher or close to public health recommendations. However, these results mask a great number of children and adolescents who are inactive or becoming inactive (40 to 45% of the population).