Age- and gender-related variations of leg power output and body composition in severely obese children and adolescents

Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults With Obesity

Background

The aim of the present study was to examine the short-term changes in body composition and physical capabilities in subjects with obesity during a multidisciplinary inpatient body weight reduction program (BWRP).

Methods

One hundred thirty-nine adolescents (56 boys and 83 girls; BMI: 37.1 ± 6.5 kg/m²; Fat Mass, FM: 45.3 ± 7.2%) and 71 adults (27 males and 44 females; BMI: 44 ± 4.7 kg/m²; FM: 51.4 ± 4.7%) followed a 3-week inpatient BWRP consisting of regular physical activity, moderate energy restriction, nutritional education and psychological counseling. Before (T0) and after the end of the BWRP (T21), body composition was assessed with an impedancemeter, lower limb muscle power with Margaria Stair Climbing Test (SCT), lower limb functionality with Short Physical Performance Battery (SPPB), and the capacity of performing activity of daily living (ADL) with Physical Performance Test (PPT).

Results

At T21, obese adolescents showed a 4% reduction in body mass (BM) (p < 0.001), associated with a FM reduction in boys (−10%) and girls (−6%) (p < 0.001) and with a 3% reduction in fat-free mass (FFM) recorded only in boys (p = 0.013). Obese adults showed a 5% BM reduction (p < 0.001), associated with a 2% FFM and 9% FM reduction (p < 0.001) in males, and 7% FM reduction in females (p < 0.001). Regarding physical capabilities, at T21 in obese adolescents, PPT score increased by 4% (p < 0.001), SCT decreased by −5% (boys) and −7% (girls) (p < 0.001), while SPPB score did not change significantly. In obese adults at T21, PPT score increased by 9% (p < 0.001), SCT decreased by −16% (p < 0.001) only in females, and SPPB score increased by 7% (males) and 10% (females) (p < 0.01).

Conclusion

In conclusion, moderate energy restriction and regular physical activity determine a 4-5% BM reduction during a 3-week inpatient BWRP, improve physical capabilities and induce beneficial changes in body composition in adolescents and adults with obesity.

Trial registration

This study was approved by the Ethical Committee of the Istituto Auxologico Italiano (Milan, Italy; research code: 01C124; acronym: PRORIPONATFIS). Registered 11 November 2020 - Retrospectively registered.

Effects of physical training on anthropometrics, physical and physiological capacities in individuals with obesity: A systematic review

Increasing the amount of physical activity is an important strategy for weight loss. This systematic review summarizes recent findings on the effects of physical training on anthropometric characteristics, physical performances and physiological capacities in individuals with overweight and obesity. A systematic literature search strategy was conducted from inception until June 2019 using four electronic databases that identified 2,708 records. After screening for titles, abstracts and full texts, 116 studies were included in our final analysis. Both aerobic (e.g., endurance training) and anaerobic training (e.g., high-intensity training, resistance training) improved body composition and physical fitness indicators in adults, adolescents and children with obesity (effect size: 0.08 < d < 2.67, trivial to very large). This systematic review suggests that both low- and high-intensity training significantly reduced body weight and fat mass while increasing fat-free mass in individuals with obesity (effect size: 0.04 Collapse

Key Words

• aerobic
• anaerobic
• exercise
• overweight
• performance

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MESH Headings

• Adolescent
• Adult
• Anthropometry
• Child
• Exercise
• Humans
• Obesity/therapy
• Overweight
• Physical Fitness

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Affiliation(s)

Hassane Zouhal Department of Sport Sciences, University of Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
Abderraouf Ben Abderrahman Higher Institute of Sport and Physical Education of Ksar-Said, Ksar-Said, Tunisia
Arash Khodamoradi Young Researchers and Elite Club, Karaj Branch, Islamic Azad University, Karaj, Iran
Ayoub Saeidi Department of Physical Education, Damghan Branch, Islamic Azad University, Damghan, Iran
Ayyappan Jayavel SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur Chengalpattu (DT), India
Anthony C Hackney Department of Exercise & Sport Science; Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
Ismail Laher Department of Anesthesiology, Pharmacology& Therapeutics, University of British Columbia, Vancouver, Canada
Amit M Algotar Department of Family and Community Medicine, University of Arizona Tucson, Arizona, USA
Georges Jabbour Department of Sport Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar

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A 3-Week Multidisciplinary Body Weight Reduction Program Improves Body Composition and Lower Limb Power Output in 3,778 Severely Obese Children and Adolescents

The aim of the present study was to investigate the effects of a 3-week in-hospital body weight reduction program (BWRP), entailing moderate energy restriction, physical activity, psychological counseling and nutritional education, on body composition and lower limb muscle power (LLP) output in obese children and adolescents. Three thousand seven hundred seventy-eight obese [BMI: 36.2 ± 5.9 kg⋅m^–2; fat mass (FM): 42.7 ± 4.0%] children and adolescents (2,318 girls and 1,460 boys, aged 8–18 year) participated in this study. Before (T0) and after the end of the BWRP (21st day, T21), body composition was assessed by an impedancemeter and LLP by the Margaria stair climbing test. Body mass (BM) and FM significantly decreased in girls (-4.8 and –7.1%, p < 0.001) and in boys (-5.5 and -9.3%, p < 0.001) after 3-week BWRP, while fat-free mass (FFM) did not change significantly in both genders. LLP expressed in absolute values (W) significantly increased in girls (by mean 6.4% from age 13 to 18 year, P < 0.001) and in boys (by mean 7.2% from age 12 to 18 year, P < 0.001). LLP normalized to BM (W⋅kg^–1BM) significantly increased in girls (by mean 11.3%, P < 0.001) and boys (by mean 12.6%, P < 0.001) from age 9 to 18 year. As well, LLP normalized to FFM (W⋅kg^–1FFM) significantly increased in girls (by mean 9.1% from age 9 to 18 year, P < 0.001) and in boys (by mean 10.1% from age 10 to 18 year, P < 0.001). In conclusion, 3-week BWRP induces a significant decrease in FM and maintenance in FFM in obese children and adolescents, these effects being also associated with a significant increase of LLP both in absolute terms and when normalized to the BM or FFM.

Comparison of two warm-up models for obese and normal-weight adults performing supramaximal cycling exercise

This study examines the impact of two forms of active warm-up on supramaximal cycling performance among sedentary adults. Thirty-seven adults [23.05 (6.4) years; BMI=26.05 (1.3) kg/m², FM=30.1 (4.2)%, VO_2max=23.8 (5.8) ml/min/kg] participated in a cross-over randomized study, and all underwent a supramaximal cycling test (SCT) following 5 minutes of two models of warm-up pedalled at a constant velocity of 60 rpm. In the first experimental condition, the warm-up was set at 50% of maximal aerobic power (WU50%MAP). In the second experimental condition, the intensity was set at 50% of maximal heart rate (WU50%MHR). During both experimental conditions the rating of perceived exertion (RPE) at the end of the warm-up and the performance reduction in percentage (ΔPr%) during the SCT were recorded. During the WU50%MAP experimental condition, obese (OB) adults showed higher values of post-warm-up heart rate (~30%) than in the normal weight (NW) group (p<0.01). In addition, the RPE scores determined after the warm-up were significantly higher in OB compared to NW (~30%; p<0.01). However, after the WU50%MHR experimental condition, no significant differences remained between OB and NW. Moreover, the analyses showed a significant positive association between the elevated heart rate values observed after WU50%MAP and both RPE and ΔPr% (r= 0.71 and r =0.81, p <0.05 respectively). In contrast to NW individuals, the WU50%MHR seems to be more suitable for the OB group undergoing the SCT given that WU50%MAP affected supramaximal cycling performances.

Clinical outcome measures for monitoring physical function in pediatric obesity: An integrative review

OBJECTIVE

Measuring physical function in children with obesity is important to provide targets for clinical intervention to reduce impairments and increase participation in activities. The objective of this integrative review was to evaluate measurement properties of performance-based measures of physical function in children with overweight and obesity.

DESIGN AND METHODS

An integrative review of literature published in Cochrane Reviews, SPORTDiscus, CINAHL, PLoS, Medline, and Scopus was conducted.

RESULTS

Twenty-eight studies were eligible and represented 66 performance-based measures of physical function. Assessments of repeatability and feasibility were not conducted in the majority of performance measures reported; only 6-min-timed walk (6MTW) was examined for test-retest repeatability. Measures of flexibility, strength, aerobic performance, anaerobic performance, coordination, and balance demonstrated construct validity and responsiveness; however, findings were inconsistent across all performance-based measures. Multi-item tests of physical function demonstrated acceptable construct validity and responsiveness; however, internal consistency was not determined.

CONCLUSIONS

There is moderate evidence that 6MTW is suitable for the measurement of physical function in children with obesity. However, evidence is low for the use of aerobic and anaerobic performance, muscle strength, Movement Assessment Battery for Children, and Bruininks-Oseretsky Test of Motor Proficiency multi-item performance instruments and very low for flexibility, coordination, and balance tests. Based on this review, measurement of physical function using 6MTW is recommended.

Mechanical efficiency improvement in relation to metabolic changes in sedentary obese adults

Purpose

Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. This performance indicator is impaired by obesity and is associated with decreased high-intensity exercise performance. However, it is unclear if ME may be improved in response to high intensity training (HIT). This study aimed to determine if ME increases in response to HIT in obese adults and to identify the factors associated with these changes.

Methods

24 obese adults (body mass index=∼33 kg/m²) were randomised into control (n=12) and trained (n=12) groups. Following baseline metabolic, anthropometric, fitness and ME measurements, the participants completed a 6-week exercise intervention that included 18 sessions of six repeats of 6 s supramaximal sprints on an electromagnetically braked cycle ergometer. The metabolic, anthropometric and fitness assessments were repeated postintervention. ME (expressed as a %) was calculated during an incremental maximal cycling test at stages of 25, 50, 75, 100 and 125 W.

Results

ME did not differ across the groups at 25 and 50 W. Following HIT, ME increased significantly at 75, 100 and 125 W (p<0.01, respectively) compared with the control group (p<0.01, respectively). Although no changes in fat-free mass were observed following HIT, the increases in ME at 75, 100 and 125 W correlated positively with both homeostasis model assessment-estimated insulin resistance index decreases (r=0.9; r=0.89 and r=0.88, p<0.01, respectively) and peak power increases (r=0.87, r=0.88 and r=0.9, p<0.01, respectively).

Conclusions

Although there were no changes in the participants’ anthropometric variables, HIT improved ME in obese adults, an enhancement that appears to be related to increases in muscle strength and metabolic adaptations.

Effects of Acute Supramaximal Cycle Exercise on Plasma FFA Concentration in Obese Adolescent Boys

AIMS

The aims of the present study are 1) to evaluate the free fatty acid (FFA) profile and 2) to determine the relative anaerobic and aerobic contributions to total energy consumption during repeated supramaximal cycling bouts (SCE) in adolescent boys with different body weight statuses.

MATERIALS AND METHODS

Normal-weight (NW), overweight (OW), and obese (OB) adolescent boys (n =15 per group) completed a SCE sessions consisted of 6 x 6s maximal sprints with 2 min of passive rest between each repetition. Plasma FFA levels were determined at rest, immediately after a 10 min warm-up, and immediately at the end of SCE. The anaerobic and aerobic contributions (%) were measured via repeated SCE bouts. Insulin resistance was calculated using the homoeostatic model assessment (HOMA-IR) index.

RESULTS

The FFA concentrations measured immediately after SCE were higher in the OB group than in the OW and NW (p<0.01 and p<0.01, respectively) groups. Moreover, the anaerobic contributions to SCE were significantly lower in obese adolescents (p<0.01) and decreased significantly during the 2nd, 3rd and 4th repetitions. The FFA levels were significantly associated with the HOMA-IR index and aerobic contribution among adolescent boys (r=0.83 and r=0.91, respectively, p<0.01).

CONCLUSION

In contrast to the NW and OW groups, there is an increase in lipid mobilization and sift to aerobic energy metabolism during SCE in the OB group.

Day-to-day physical functioning and disability in obese 10- to 13-year-olds

What is already known about this subject? Compared with their healthy-weight peers, children with obesity have; impaired physical health-related quality of life reduced physical activity levels reduced capacity to perform certain weight-bearing tasks in field-based fitness tests What this study adds? First investigation of obesity-related disability in children using the International Classification for Functioning, Disability and Health framework for Children and Youth. Obesity in children appears to be associated with disability impacting basic locomotor skills and physical health-related quality of life. Children's participation in key life areas related to physical functioning appears to be minimally impacted by obesity.

OBJECTIVE

The aim of this study was to investigate whether obesity is related to impaired day-to-day physical functioning and disability in children.

METHODS

An observational case-control study was conducted in three Australian states. Obese (n = 107) and healthy-weight (n = 132) 10- to 13-year-olds (132 male, 107 female) were recruited via media advertisements. Assessment of body composition (dual energy X-ray absorptiometry), locomotor capacity (six-minute walk test [6MWT], timed up and down stairs test [TUDS] and timed up and go [TUG]) and child-reported physical health-related quality of life (HRQoL) were undertaken. Participants wore an accelerometer for 8 days and completed two use-of-time telephone interviews to assess participation in key life areas.

RESULTS

Compared with their healthy-weight counterparts, obese children had lower physical HRQoL scores (P < 0.01) and reduced locomotor capacity (TUDS z-score, TUG and 6MWT; P < 0.01). Higher percent body fat was significantly related to lower physical HRQoL scores (r = -0.48, P < 0.01), slower performance times for the TUDS and TUG (r = 0.59 and 0.26 respectively, P < 0.01), shorter 6MWT distances (r = -0.51, P < 0.01) and reduced time spent in community participation activities (r = -0.23, P < 0.01).

CONCLUSIONS

As anticipated, obesity appears to undermine physical functioning in children, including the capacity to perform basic locomotor skills yet, unexpectedly, participation in key life areas related to physical functioning appeared largely unaffected.

Mechanical efficiency during a cycling test is not lower in children with excess body weight and low aerobic fitness

OBJECTIVE

The aims of this study were to assess the association between (i) body weight status and mechanical efficiency (ME); and (ii) ME and aerobic fitness in children aged 8-10 years.

DESIGN AND METHODS

The sample included 464 prepubertal children (258 boys). A total of 288 were normal-weight (NW); 84 overweight (OW); and 92 obese (OB). Subjects performed an incremental maximal cycling test with indirect calorimetry. MEcrude (%) was calculated for the first five stages of the protocol (25, 50, 75, 100, and 125 W) as follows: work produced, in watts total energy consumption, in watts(-1) · 100(-1). For MEnet, resting energy consumption was subtracted from total energy consumption. Energy consumption was calculated as follows: (4.94 · respiratory exchange ratio + 16.04) · VO2, in ml · min(-1) · 60(-1).

RESULTS

MEcrude was significantly higher in NW compared to OW and OB children and in OW compared to OB children at 25, 50, 75, 100, and 125 W. In contrast, MEnet did not differ significantly among NW, OW, and OB children. No statistically significant association was found between crude or net ME and peak oxygen consumption (VO2 peak; in ml · kg(-1) · min(-1)); therefore, the ability to transfer chemical energy to mechanical work is maintained in children aged 8-10 years old regardless of body weight status and aerobic fitness. Moreover, higher values of MEcrude during exercise are explained by elevated oxygen consumption at rest and not by energy consumed during physical activity.

CONCLUSIONS

These results highlight that prepubertal children are equally efficient since they are able to perform a physical task such as cycling using the same proportion of energy regardless of their body weight status.

Catecholamine response to exercise in obese, overweight, and lean adolescent boys

INTRODUCTION

The aim of this study was to examine the effect of body fat percentage on the plasma catecholamine response to a cycling sprint test (CST) in sedentary adolescent boys.

METHODS

In this study, 31 adolescent boys (9 obese (% body fat = 31.0% ± 3.0%), 11 overweight (% body fat = 24.0% ± 1.6%), and 11 lean (% body fat = 16.0% ± 1.9%)), matched for peak oxygen consumption, completed a CST consisting of six 6-s maximal sprints with 2 min of passive rest between each repetition. Performance of each subject was determined as the mean power output (PO(mean)) developed during the CST. Plasma lactate, epinephrine, and norepinephrine concentrations were determined successively at rest, after a 10-min warm-up, immediately after the CST, and after 20 min of passive recovery.

RESULTS

Although groups were not different in age, height, or peak oxygen consumption (mL·kg(-1) fat-free mass·min(-1)), maximal epinephrine concentration was significantly (P < 0.05) higher in lean vs obese and was negatively correlated to body fat percentage (r = -0.60, P < 0.05). Maximal norepinephrine values were higher in lean versus overweight and obese, and a negative relationship was found between maximal norepinephrine concentration and body fat percentage (r = -0.60, P < 0.05). Maximal lactate concentration was higher in lean versus overweight and obese (14.7 ± 3.3, 10.4 ± 2.7, and 10.2 ± 2.5 mM in lean, overweight, and obese, respectively). A significant relationship was also obtained between maximal norepinephrine and maximal epinephrine values with both maximal lactate concentration (r = 0.60 and r = 0.60, P < 0.05, respectively) and PO(mean) (r = 0.65 and r = 0.6, P < 0.05).

CONCLUSIONS

Our results show that the catecholamine response to a CST was affected by body fat percentage, with reduced epinephrine and norepinephrine values in overweight and obese adolescents.

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.