Physical activity in management of persons with obesity

Southeast Asian, African, and Middle East Expert Consensus on Structured Physical Activity-Dance, Exercise, and Sports

Physical inactivity (PIA) is a pressing public health issue globally, contributing significantly to the rise of non-communicable diseases (NCD), such as cardiovascular disease and type 2 diabetes. The World Health Organization emphasises the importance of regular physical activity (PA) for preventing and managing NCDs. Initiatives to promote active living have gained momentum, ranging from community programs to workplace wellness campaigns, all focused on reducing sedentary lifestyles in modern society. Structured Physical Activity-Dance, Exercise, and Sports (SPADES) has emerged as an innovative approach to addressing PIA and promoting holistic health. After thoroughly reviewing existing literature from PubMed and Google Scholar databases, a panel of experts developed consensus statements through in-depth discussions, and the strength of concurrence on these statements was voted on using a Likert scale. The panel reached a consensus on the best strategies for PA, dance, exercise, sports, and key factors to consider during PA. This consensus targets individuals with metabolic diseases, particularly in regions like South Asia, East Africa, the Gulf, and Latin America, where these conditions are highly prevalent. The SPADES guidelines emphasise overcoming the barriers people with metabolic disorders face in achieving adequate PA, providing tailored recommendations to improve health outcomes for this population.

Clinical Assessment of Altered Eating Behaviors in People with Obesity Using the EBA-O Questionnaire

Background/Objectives: Over the past decade, numerous studies have explored the bidirectional relationship between obesity and mental health, mainly eating disorders (EDs). This study aimed to assess the prevalence and characteristics of altered eating behaviors (AEBs) in a cohort of people with obesity (PwO) using the validated Eating Behaviors Assessment for Obesity (EBA-O). Methods: We conducted a cross-sectional study from May 2023 to April 2024, recruiting consecutive PwO seeking weight loss. Participants completed the 18-item EBA-O questionnaire, which focuses on five primary eating behaviors: night eating, food addiction, sweet eating, hyperphagia, and binge eating. Unlike other validated tools, the EBA-O is specifically designed to capture these behaviors in PwO and is easy for patients to self-administer. We also collected sociodemographic and clinical data. Results: A total of 127 participants were included (76 women, median age 52 years, median BMI 42.9 kg/m2). We found a significant prevalence of AEBs: 33.1% for sweet eating, 23.6% for hyperphagia, 15.7% for food addiction, 14.2% for binge eating, and 7.1% for night eating. The EBA-O scores correlated positively with BMI (r = 0.201, p = 0.024) and increased across BMI categories (p = 0.001). Males had higher scores for night eating and hyperphagia (p = 0.01), and active smokers had higher hyperphagia scores (p = 0.043) than ex-smokers and non-smokers. The night eating scores were inversely correlated with sleep hours (r = -0.197, p = 0.026), and food addiction was positively correlated with age (r = 0.261, p = 0.003); conversely, hyperphagia (r = -0.198, p = 0.025) and binge eating (r = -0.229, p = 0.010) were inversely correlated with age. PwO without diabetes had higher scores for food addiction (p = 0.01) and binge eating (p = 0.004) compared to those with diabetes. Conclusions: These results highlight the potential to characterize PwO based on their AEBs, offering new opportunities to tailor treatment strategies for PwO by targeting specific eating behaviors.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Association of domain-specific physical activity with nocturia: a population-based study

Nocturia is the most prevalent lower urinary tract symptom (LUTS) and is closely associated with various diseases and social burdens. Research on the relationship between physical activity and various diseases has progressed significantly. However, the association between nocturia and physical activity has received limited attention in prior studies. Thus, this study aimed to investigate the relationship between different domains of physical activity (e.g., occupation-related physical activity [OPA], transportation-related physical activity [TPA], and leisure-time physical activity [LTPA]) and nocturia. We included 5516 participants from the cross-sectional National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2012, employing survey-weighted logistic regression, restricted cubic splines (RCS), subgroup analysis, and sensitivity analysis to assess the relationship between different domains of physical activity and nocturia. Multivariable logistic regression analysis revealed a significant negative correlation between PA, LTPA, and nocturia. Specifically, PA (OR 0.7523, 95% CI 0.6307-0.8974, P = 0.002) and LTPA (OR 0.7664, 95% CI 0.6314-0.9304, P = 0.007) were negatively associated with nocturia. The RCS curve demonstrated non-linear relationships between PA, LTPA, and nocturia. Additionally, subgroup analyses and sensitivity analyses further validated this association. Based on this cross-sectional study, we suggested that PA and LTPA are associated with a reduced risk of nocturia in adults aged 20 years and older in the United States. This underscores the importance of physical activity in preventing and managing nocturia may provide valuable guidance for clinical practice.

Effect of Low- and Moderate-Intensity Aerobic Training on Body Composition Cardiorespiratory Functions, Biochemical Risk Factors and Adipokines in Morbid Obesity

BACKGROUND

Obesity poses an enormous public health and economic burden worldwide. Visceral fat accumulation is associated with various metabolic and cardiovascular consequences, resulting in an increased prevalence of atherosclerotic conditions. We aimed to examine the impact of low-and moderate-intensity aerobic training on several anthropometric and cardiorespiratory parameters and markers of atherosclerosis, including inflammation, serum levels of lipoproteins and adipokines of extremely obese patients in poor condition.

METHODS

Forty severely obese patients were recruited and randomized into two groups, Group 1 and Group 2, for a six-week inpatient study. Group 1 received moderate-intensity (40-60% heart rate reserve) and Group 2 received low-intensity (30-39% of heart rate reserve) aerobic training combined with resistance training. The patients' cardiorespiratory functions were assessed by ergospirometry. Anthropometric data were recorded, body composition was analyzed and functional tests were performed. We also investigated serum lipids and high-sensitive C-reactive protein levels and calculated the homeostatic model assessment-insulin resistance indices and adipokine levels as predictive biomarkers.

RESULTS

Functional abilities and some biochemical parameters, such as homeostatic model assessment-insulin resistance, serum lipids, apolipoprotein A and apolipoprotein-B improved in both groups in a positive direction. However, cardiorespiratory capacity and the serum levels of high-sensitive C-reactive protein and Lipocalin-2 decreased, while irisin and paraoxonase 1 increased significantly, but only in Group 1.

CONCLUSIONS

Six weeks of aerobic training, regardless of its intensity, could induce favorable changes in functional tests, body composition and serum lipids, even in severely obese, extremely unconditioned patients in both groups. However, moderate-intensity aerobic training should at least increase cardiorespiratory capacity and yield a better lipid profile oxidative status and inflammation profile.

Diet and physical exercise in elderly people with obesity: The state of the art

Obesity is a disease that is assuming pandemic proportions in recent decades. With the advancement of medicine and increased access to care, average survival has increased, resulting in a larger number of elderly people. As a result, the amount of elderly people living with obesity is increasing, and the morbidity and impact of obesity on ageing implies severe limitations for these people. The link between obesity and ageing is not only epidemiological, but also strictly pathophysiological. Obesity accelerates the ageing process and ageing is characterised by pathophysiological mechanisms shared by obesity itself. Some examples of alterations shared by ageing and obesity are metabolic changes, sarcopenia and reduced functional capacity related to both loss of muscle strength and reduced cardiorespiratory fitness, as well as a general reduction in the perception of quality of life. The specific ability to antagonize these mechanisms through non-pharmacological treatment based on nutrition and exercise has always been one of the focal points of the international literature. Therefore, this review provides the state of the art on scientific knowledge regarding the main effects of an adequate nutritional plan and an individualised exercise prescription on the general health of elderly with obesity. In particular, this paper addresses the effect of nutrition and physical exercise on pathophysiological changes peculiar of ageing and obesity, providing also the scientific rational for nutritional and exercise prescription in the population.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Renoprotective effects of empagliflozin in high-fat diet-induced obesity-related glomerulopathy by regulation of gut-kidney axis

The increasing prevalence of obesity-related glomerulopathy (ORG) poses a significant threat to public health. Sodium-glucose cotransporter-2 (SGLT2) inhibitors effectively reduce body weight and total fat mass in individuals with obesity and halt the progression of ORG. However, the underlying mechanisms of their reno-protective effects in ORG remain unclear. We established a high-fat diet-induced ORG model using C57BL/6J mice, which were divided into three groups: normal chow diet (NCD group), high-fat diet (HFD) mice treated with placebo (ORG group), and HFD mice treated with empagliflozin (EMPA group). We conducted 16S ribosomal RNA gene sequencing of feces and analyzed metabolites from kidney, feces, liver, and serum samples. ORG mice showed increased urinary albumin creatinine ratio, cholesterol, triglyceride levels, and glomerular diameter compared with NCD mice (all P < 0.05). EMPA treatment significantly alleviated these parameters (all P < 0.05). Multitissue metabolomics analysis revealed lipid metabolic reprogramming in ORG mice, which was significantly altered by EMPA treatment. MetOrigin analysis showed a close association between EMPA-related lipid metabolic pathways and gut microbiota alterations, characterized by reduced abundances of Firmicutes and Desulfovibrio and increased abundance of Akkermansia (all P < 0.05). The metabolic homeostasis of ORG mice, especially in lipid metabolism, was disrupted and closely associated with gut microbiota alterations, contributing to the progression of ORG. EMPA treatment improved kidney function and morphology by regulating lipid metabolism through the gut-kidney axis, highlighting a novel therapeutic approach for ORG. NEW & NOTEWORTHY Our study uncovered that empagliflozin (EMPA) potentially protects renal function and morphology in obesity-related glomerulopathy (ORG) mice by regulating the gut-kidney axis. EMPA's reno-protective effects in ORG mice are associated with the lipid metabolism, especially in glycerophospholipid metabolism and the pantothenate/CoA synthesis pathways. EMPA's modulation of gut microbiota appears to be pivotal in suppressing glycerol 3-phosphate and CoA synthesis. The insights into gut microbiota-host metabolic interactions offer a novel therapeutic approach for ORG.

Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT Study

BACKGROUND

Numerous studies have examined associations between overweight and obesity and risk of low back pain (LBP), but the exact magnitude of these associations is not yet clear. The purpose of this work was to assess such sex-specific associations in a community-based setting in Norway, taking into account potential relationships with other risk factors.

METHODS

A cohort study was conducted combining data from two waves of the Trøndelag Health Study, HUNT3 (2006-2008) and HUNT4 (2017-2019). Separate analyses were performed of risk of chronic LBP in HUNT4 among 14,775 individuals without chronic LBP in HUNT3, and of recurrence or persistence in HUNT4 among 5034 individuals with chronic LBP in HUNT3. Relative risks were estimated in generalised linear models for overweight and obesity compared to normal weight. Body size classification was based on values of BMI computed from measurements of height and weight. Chronic LBP was defined as LBP persisting at least 3 months during last year.

RESULTS

After adjustment for age, smoking, physical activity in leisure time and work activity, analysis of risk among women produced relative risks 1.11 (95% CI 1.00-1.23) for overweight, 1.36 (95% CI 1.20-1.54) for obesity class I and 1.68 (95% CI 1.42-2.00) for obesity classes II-III. Relative risks among men were 1.10 (95% CI 0.94-1.28) for overweight, 1.36 (95% CI 1.13-1.63) for obesity class I and 1.02 (95% CI 0.70-1.50) for obesity classes II-III, the last estimate being based on relatively few individuals. Analyses of recurrence or persistence indicated similar relationships but with smaller magnitude of relative risks and no drop in risk among obesity classes II-III in men. The change in BMI from HUNT3 to HUNT4 hardly differed between individuals with and without chronic LBP in HUNT3.

CONCLUSIONS

Risk of chronic LBP increases with higher values of BMI in both sexes, although it is uncertain whether this applies to very obese men. Very obese women carry a particularly large risk. Probabilities of recurrence or persistence of chronic LBP among those already afflicted also increase with higher values of BMI. Adjustment for other factors does not influence relationships with overweight and obesity to any major extent.

Dietary and Lifestyle Strategies for Obesity

The prevalence of obesity globally has tripled over the last half century, and currently affects around 650 million adults and 340 million children and adolescents (ages 5-19 years). Obesity contributes towards >50 co-morbidities and premature mortality. Obesity is a highly stigmatised condition that is associated with much mental and emotional distress and dysfunction. Thus, obesity is a major contributor to healthcare expenditure globally. Traditionally, the management of obesity stratifies into three major groups that include metabolic (bariatric) surgery, pharmacotherapies, and lifestyle (primarily dietary) strategies. Although listed as a separate category, dietary strategies for obesity remain a central component of any management plan, and often complement other surgical and pharmacotherapeutic options. Indeed, the effectiveness of any management approach for obesity relies upon successful behavioural changes, particularly relating to eating behaviours. In this concise review, we explore the foundational pillars of dietary strategies for obesity: sleep, listening, routine, de-stressing and optimisation of social conditions. We then discuss the importance of balancing dietary macronutrients (including dietary fibre, carbohydrates, protein and ultra-processed foods [UPFs]) as a key dietary strategy for obesity. Although we focus on general principles, we should provide bespoke dietary strategies for our patients, tailored to their individual needs. Rather than judging the utility of a diet based simply on its associated magnitude of weight loss, we should adopt a more holistic perspective in which a dietary strategy is valued for its overall health benefits, including the nurturing of our gut microbiota, to enable them to nurture and protect us.

Life's essential 8, genetic susceptibility, and risk of inflammatory bowel diseases: a population-based cohort study

BACKGROUND

Evidence has shown that the individual metrics in Life's Essential 8 (LE8), an updated cardiovascular health (CVH) concept proposed by the American Heart Association, play a role in the development of inflammatory bowel disease (IBD). However, epidemiological evidence on the overall LE8 on IBD risk remains limited. We aimed to assess the longitudinal associations of LE8-defined CVH and the risks of IBD and its subtypes, ulcerative colitis (UC) and Crohn's disease (CD). We also tested whether genetic susceptibility could modify these associations.

METHODS

A total of 260,836 participants from the UK Biobank were included. LE8 scores were determined by 8 metrics (physical activity, diet, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, and blood lipids), and were divided into three levels: low CVH (0-49), moderate CVH (50-79), and high CVH (80-100). Cox proportional hazards models were used to calculate the hazard ratios (HRs) and confidence intervals (CIs) of the risk of IBD in relation to CVH status.

RESULTS

Over a median follow-up 12.3 years, we documented 1,500 IBD cases (including 1,070 UC and 502 CD). Compared to participants with low CVH, the HRs (95% CIs) of those with high CVH for IBD, UC, and CD were 0.67 (0.52, 0.83), 0.70 (0.52, 0.93), and 0.55 (0.38, 0.80), respectively. These associations were not modified by genetic susceptibility (all P for interactions > 0.05). The lowest HR (UC: 0.30, 95% CI: 0.20-0.45; CD: 0.33, 95% CI: 0.20-0.57) was observed in participants with both high CVH and low genetic risk.

CONCLUSIONS

Better CVH, defined by LE8, was associated with significantly lower risks of IBD, UC, and CD, irrespective of genetic predisposition. Our results underscore the importance of adherence to LE8 guidelines for maintaining CVH as a potential strategy in the prevention of IBD.

Level and limitations of physical activity in patients with excess body weight or diabetes

Physical activity (PA) is recommended to prevent or treat many diseases, but various factors may limit it. We analyse the level of PA and the barriers to undertaking it. Patients aged 18-64 with diabetes or at least overweight completed the following questionnaires: International Physical Activity Questionnaire (IPAQ) and Accompanying Survey (AS). For statistical analysis, non-parametric Mann-Whitney U, χ2-Pearson, correspondence analysis and meta-analysis (OR with ±95% CI) were used, and α=0.05 was assumed. Of 191 sets of questionnaires were analysed (67% from women). The median (MD) age for the group was 50.5 years, MD for metabolic equivalents (METs): 2079 (MET-min/week); 16.23% of subjects scored insufficient, 46.07% sufficient and 37.7% high PA according to the IPAQ scale. A relationship between the IPAQ and PA level results from the AS was confirmed (χ2; p=0.00047). The most common reasons indicated for not taking up PA were lack of time due to professional work (49%) and additional duties (32%) as well as fatigue from daily duties (44%). Participants <45 years were more likely to indicate additional duties (p=0.013), participants >45 years illnesses (p=0.04) and people with BMI (body mass index) ≥30 kg/m2, 'fatigue from daily duties' (p=0.019) as an obstacle to undertaking PA. 'Lack of suitable conditions to undertake PA' was indicated more often by patients with primary education (p<0.01), diabetes (p=0.037), after myocardial infarction (p=0.039) and those under psychiatric treatment (p=0.039). Women more often declared a lack of motivation (p=0.018). Residents of big cities and those with BMI ≥30 were more likely to assess their PA as 'insufficient' (p=0.0260 and p=0.0081, respectively). The overwhelming number of respondents who were in the age of professional activity had a sufficient level of PA. The most common barriers to undertaking PA were lack of time and fatigue, related to both work and non-work activities, but specific barriers were also found for women and patients with various diseases.

Effect of Combined Physical Exercise Training in Reducing Cardiovascular Risk Among Adults with Obesity: A Randomized Clinical Trial

It is necessary to understand the relationship between different models of exercise periodization and the reduction of cardiovascular risk in adults with obesity. The aim of this study was to verify the effect of two periodization models of combined training on the cardiovascular risk of adults with obesity of both sexes. A randomized clinical trial was conducted with adults of both sexes with obesity. They were divided into three groups: control group (CG), non-periodized combined training group (NG), and combined training group with linear periodization (PG). The NG and PG groups underwent physical exercise training regimen for 16 weeks, in three weekly sessions of 60 min each, with the volume and intensity equalized. Cardiovascular risk was measured by the overall Framingham risk score (FRS). Generalized estimation equations and individual responsiveness analyses were used, stratified by sex. A statistically significant reduction in FRS was observed only in men of the NG (pre: 2.50 ± 0.56; post: 0.50 ± 1.02; p-value = 0.001). There was no statistically significant intervention effect on the women's cardiovascular risk. It was found that, regardless of sex, subjects in the control group mostly presented results of increased cardiovascular risk. In contrast, those belonging to the exercise groups, if not reduced, at least stabilized the chances of suffering a cardiovascular event in the next ten years after 16 weeks of combined training. Sixteen weeks of non-periodized combined training were sufficient to reduce cardiovascular risk in men with obesity. Both periodization models were important to stabilize the risk of developing a cardiovascular disease in the next 10 years.

Italian Association of Hospital Cardiologists position paper-obesity in adults: a clinical primer

Obesity is a chronic and relapsing disease characterized by the interaction between individual predispositions and an obesogenic environment. Recent advances in understanding the mechanisms of energetic homoeostasis paved the way to more effective therapeutic approaches compared with traditional treatments. Since obesity is a complex disease, it necessitates a multi-disciplinary approach whose implementation remains challenging. Nonetheless, emerging pharmacological interventions appear promising. Currently, therapeutic success is discreet in the short term but often fails to maintain long-term weight loss due to a high likelihood of weight regain. Cardiologists play a key role in managing patients with obesity, yet often lack familiarity with its comprehensive management. The aim of this document is to summarize knowledge to consolidate essential knowledge for clinicians to effectively treat patients living with obesity. The paper emphasizes the pivotal role of a strong patient-clinician relationship in navigating successful treatment. We analyse the criteria commonly used to diagnose obesity and point out the strengths and limitations of different criteria. Furthermore, we discuss the role of obesiologists and the contributions of cardiologists. In addition, we detail key components of effective therapeutic strategies, including educational aspects and pharmacological options.

Physical activity in metabolic syndrome

Obesity has become one of the global epidemics, contributing to the burden of disease in society, increasing the risk of diabetes, cardiovascular and liver diseases. Inadequate energy balance resulting from excessive energy intake and insufficient physical activity (PA) is one of the main factors contributing to the incidence of obesity and the development of metabolic syndrome (MetS). Treatment options for obesity include lifestyle modifications, pharmacotherapy and bariatric surgery, with the latter being the most effective treatment. Lifestyle interventions involving increased PA and reduced caloric intake improve metabolic outcomes. Early implementation of exercise leads to improved physical fitness, better glycemic control and lipid profile. Undertaking systematic PA is associated with better quality of life, improves insulin sensitivity, causes additional weight loss, reduces its adverse effects on bone mass and results in better body composition. In this narrative review we summarized the current state of knowledge on the impact of PA on the components of MetS and the latest recommendations for PA in patients with MetS.

Dietary and Lifestyle Risk Factors of Obesity Among Young Adults: A Scoping Review of Observational Studies

PURPOSE OF REVIEW

Obesity is a growing public health concern worldwide, especially among young adults. This scoping review aims to identify and summarize the current evidence on dietary and lifestyle risk factors associated with obesity among young adults.

RECENT FINDINGS

A scoping review was performed using the PRISMA-ScR guidelines. A systematic search of five electronic databases published from inception to October 2023 was conducted. A total of 46 observational studies met the inclusion criteria and were included in the review. The findings suggest that high intake of energy-dense foods, unhealthy eating habits, poor sleep quality, and increased screen time were significant risk factors for obesity among young adults. In contrast, the association between obesity and sedentary behavior, low physical activity levels, alcohol consumption, and smoking habits was inconclusive. The reviewed evidence suggests that unhealthy dietary habits and lifestyle behaviors are associated with an increased risk of obesity among young adults. The findings highlight the need for further research on these modifiable risk factors to prevent and manage obesity among young adults.

The effect of regular running on body weight and fat tissue of individuals aged 18 to 65

BACKGROUND

Age and reduction in performed physical activity cause physiological changes that include an increase in body fat (BF) and visceral fat (VF) during aging. These parameters, together with increased body mass (BM), are some of the risk factors of several noninfectious diseases. However, changes in body composition can be influenced by regular physical activity. Running is a suitable, accessible, and the most effective physical activity cultivating people. The objective of this study is to investigate the effects of long-term, regular PA, specifically recreational running, on changes in body composition among recreational adult runners covering a weekly distance of at least 10 km, compared with inactive adult individuals within the same age bracket.

METHODS

The study included 1296 runners and inactive individuals (691 male and 605 female), divided into 5 age groups: 18-25, 26-35, 36-45, 46-55, and 56-65 years. Runners are as follows: ran ≥ 10 km/week, and inactive is as follows: did not follow the WHO 2020 physical activity recommendations. The measured parameters included BM, BF, and VF. To check statistical significance, the Mann-Whitney U-test was used. Practical significance was assessed using the effect of size.

RESULTS

All age groups of runners were selected to include individuals who run at least 10 km per week. In fact, they ran, on average, from 21.6 to 31.4 km per week in relation to age and showed significantly lower values of BM, BMI, BF, and VF (p < 0.05) than inactive individuals. Exceptions included insignificant differences (p > 0.05) in BM and BMI in males in the age category of 18-25 and in females in the age category of 18-25 and 26-35.

CONCLUSION

The selected runners had to run at least 10 km per week. Their actual average volume was significantly higher (from 21.6 to 31.4 km/week), and the results showed that it could lead to significantly better body composition values. It may lead to significant changes in body mass, body fat, and visceral fat. It may meet the contemporary societal expectations for physical activities that are both achievable and effective at the lowest possible volume.

Causal association of physical activity with low back pain, intervertebral disc degeneration and sciatica: a two-sample mendelian randomization analysis study

Objective: Previous studies are insufficient to confirm a causal association between physical activity (PA) and low back pain (LBP), intervertebral disc degeneration (IDD), and sciatica. The present study used a two-sample Mendelian randomization (MR) analysis method to demonstrate whether or not there was a causal connection. Methods: First, four PA phenotypes were selected [accelerometer-based PA (average acceleration), accelerometer-based PA (acceleration fraction >425 mg), self-reported moderate-to-vigorous PA, and self-reported vigorous PA], setting thresholds for single nucleotide polymorphisms (SNPs) significantly concerned with PA p < 5 × 10-8, linkage disequilibrium (LD) r 2 < 0.01, genetic distance >5,000 kb, and F-value >10. SNPs associated with the outcome and confounding factors were then excluded using the PhenoScanncer database. Finally, after coordinating the genetic instruments from genome-wide association studies (GWAS) effect alleles for exposure and outcomes, multiplicative random effects inverse variance weighting (IVW), MR-Egger, weighted median method (WMM), and weighted mode method were used to assess exposure-outcome causality and perform sensitivity analysis on the estimated results. Results: The current study's IVW findings revealed proof of a causal connection between PA and LBP. While there was a positive causal tie between accelerometer-based PA (acceleration fraction >425 mg) and LBP [OR: 1.818, 95% CI:1.129-2.926, p = 0.012], there was a negative causal link between accelerometer-based PA (average acceleration) and LBP [OR: 0.945, 95% CI: 0.909-0.984, p = 0.005]. However causal relationship between PA and IDD or sciatica was not found. Conclusion: Increasing average PA but needing to avoid high-intensity PA may be an effective means of preventing low back pain. Although PA is not directly causally related to disc degeneration and sciatica, it can act through indirect pathways.

Metabolic diseases and healthy aging: identifying environmental and behavioral risk factors and promoting public health

Aging is a progressive and irreversible pathophysiological process that manifests as the decline in tissue and cellular functions, along with a significant increase in the risk of various aging-related diseases, including metabolic diseases. While advances in modern medicine have significantly promoted human health and extended human lifespan, metabolic diseases such as obesity and type 2 diabetes among the older adults pose a major challenge to global public health as societies age. Therefore, understanding the complex interaction between risk factors and metabolic diseases is crucial for promoting well-being and healthy aging. This review article explores the environmental and behavioral risk factors associated with metabolic diseases and their impact on healthy aging. The environment, including an obesogenic environment and exposure to environmental toxins, is strongly correlated with the rising prevalence of obesity and its comorbidities. Behavioral factors, such as diet, physical activity, smoking, alcohol consumption, and sleep patterns, significantly influence the risk of metabolic diseases throughout aging. Public health interventions targeting modifiable risk factors can effectively promote healthier lifestyles and prevent metabolic diseases. Collaboration between government agencies, healthcare providers and community organizations is essential for implementing these interventions and creating supportive environments that foster healthy aging.

Latin American and the Caribbean Code Against Cancer 1st edition: Weight, physical activity, diet, breastfeeding, and cancer

In Latin America and the Caribbean a considerable proportion of the population have excess body weight, do not meet the recommendations of physical activity and healthy diet, and have suboptimal rates of breastfeeding. Excess body weight is associated with at least 15 cancer sites, physical activity protects against three cancers, with some evidence suggesting a protective effect for eight more cancer sites, and sedentary behavior probably increases the risk of five cancer sites. Fiber and wholegrains protect against colorectal cancer, high intake of fruits and vegetables could reduce the risk of aerodigestive cancers; processed and red meat increase the risk of colorectal cancer; and very hot beverages are associated with esophageal cancer. Moreover, sugar-sweetened beverages and ultra-processed foods are a convincing cause for excess body weight, increasing cancer risk through this pathway, with some emerging evidence suggesting also direct pathways. Breastfeeding protects against breast cancer, and could protect against ovarian cancer. Taking this evidence into account, the Latin America and the Caribbean Code Against Cancer recommends the general public to maintain a healthy body weight, be physically active and limit sedentary behavior, eat a healthy diet (eat plenty of vegetables, fruits, wholegrains and legumes; avoid sugar-sweetened beverages and processed meat; and limit ultra-processed foods, red meat and very hot beverages), and breastfeed. Moreover, the Latin America and the Caribbean Code Against Cancer also includes a set of public policy recommendations for cancer prevention to inform policy makers and civil society about the need of policies to shape healthy environments and create opportunities to facilitate the adoption of the recommendations directed to the public.

Physical activity and exercise for weight loss and maintenance in people living with obesity

Physical activity and exercise training programs are integral part of a comprehensive obesity management approach. In persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight loss compared to the absence of training. However the magnitude of effect remains modest amounting to only 2-3 kg additional weight loss on average. Comparable effects have been observed for total fat loss. Exercise training, specifically aerobic training, is also associated with decreased abdominal visceral fat as assessed by imaging techniques, which is likely to benefit cardiometabolic health in persons with obesity. Based on data from controlled trials with randomization after prior weight loss, the evidence for weight maintenance with exercise training is as yet not conclusive, although retrospective analyses point to the value of relatively high-volume exercise in this regard. Resistance (i.e. muscle-strengthening) training is specifically advised for lean mass preservation during weight loss. Given the relatively limited effect of exercise training on weight loss as such, the changes in physical fitness brought about by exercise training cannot be overlooked as they provide major health benefits to persons with obesity. Aerobic, as well as combined aerobic and resistance training, increase cardiorespiratory fitness (VO2max) while resistance training, but not aerobic training, improves muscle strength even in the absence of a significant change in muscle mass. Regarding the overall management strategy, adherence in the long term to new lifestyle habits remains a challenging issue to be addressed by further research.

Knowledge and adherence to the Mediterranean diet in individuals practicing regular amatorial physical activity: a cross-sectional study conducted in the Metropolitan Area of Palermo, Italy

Introduction

Mediterranean Diet (MD) is a universal model of nutrition that prevents several metabolic, cardiovascular, and oncological diseases. Main objective of the present study was to analyze adherence and knowledge regarding MD principles in a sample of individuals practicing amatorial sports from the Metropolitan Area of Palermo.

Methods

A cross-sectional study was conducted in 10 Sports Centers, between October 2020 and September 2021, through a previously validated anonymous questionnaire structured in five sections including 74 items.

Results

Overall, 337 subjects answered to the questionnaire. Based on the multivariable analysis conducted, a higher knowledge score (KS) on MD principles was observed among individuals daily consuming vegetables (OR: 3.32; CI95%: 1.82-6.02) and in the ones more adherent to MD principles (OR: 10.15; CI95%:5.47-18.85). More in depth, using MEDAS score to analyze the adherence to MD, a significant lower adherence was observed among overweight/obese (OR: 0.57; CI95%:0.33-0.99) and among employed subjects (OR: 0.52; IC95%: 0.28-0.98); while, a higher adherence was highlighted among daily consumers of vegetables (OR: 2.52; CI95%:1.52-4.17), daily consumers of fruit (OR: 1.77; CI95%:1.08-2.90), and in individuals that have daily breakfast (OR: 4.29; CI95%:1.15-15.96).

Discussion

In accordance with the WHO Europe Gaining Health Campaign, Public Health Authorities should simplify accessibility to healthy food among general population, promoting principles and accessibility to MD.

Lifestyle Changes during the SARS-CoV-2 Pandemic as Predictors of BMI Changes among Men and Women in Poland

BACKGROUND

Social isolation during the SARS-CoV-2 pandemic affected people's body weight, therefore, this study was designed to evaluate the association between lifestyle elements and the change in BMI during lockdown.

METHODS

This retrospective observational study involved 290 questionnaires completed by adult participants divided into three groups according to BMI change during isolation. The structured questionnaire included a general description of the study objective and collected data regarding sociodemographics, anthropometrics, physical activity, sedentary behaviour, sleep duration, and food intake pre- and during COVID-19 lockdown.

RESULTS

A decrease or increase in BMI was found in 23.6% and 47.8% of women and 18.5% and 42.6% of men, respectively. Among those who lost weight, 46.5% of women and 40% of men followed a diet of their own choice, 30.2% of women and 25% of men changed their product mix and reduced their intake, 40% of men stopped eating outside the home. An increase in BMI was associated with increased food intake (32.2% of women and 28.3% of men), increased sleep duration on weekdays (49.2% of women and 43.5% of men) and, in more than 50% of subjects, decreased physical activity. In women, increased BMI was associated with the highest frequency of snacking (p = 0.0003), the highest intake of sweets (p = 0.0021), and in men with the highest intake of alcohol (p = 0.0017).

CONCLUSIONS

The observed changes in BMI during social isolation were the result of lifestyle modifications including dietary behaviour and differed by gender.

Support Provided by Caregivers for Community-Dwelling Obesity Individuals: Focus on Elderly and Hispanics

Obesity is a chronic disease marked by the buildup of extra adipose tissue and a higher chance of developing concomitant illnesses such as heart disease, diabetes, high blood pressure, and some malignancies. Over the past few decades, there has been a global increase in the prevalence of obesity, which now affects around one-third of the world's population. According to recent studies, a variety of factors, including genetics and biology as well as environmental, physiological, and psychosocial factors, may have a role in the development of obesity. The prevalence of obesity is often higher among Hispanic American groups than among White people in the U.S. Obesity is a widespread condition with a high risk of morbidity and death, and it is well-recognized that the prevalence of comorbidities rises with rising levels of obesity or body mass index. To combat the rising prevalence of obesity in the USA, especially among Hispanics, one of the fastest-growing racial/ethnic groups in the country, there is an urgent need for obesity therapies. The exact cause of this disparity is unclear, but some responsible factors are a lack of education, high unemployment rates, high levels of food insecurity, an unhealthy diet, inadequate access to physical activity resources, a lack of health insurance, and constricted access to culturally adequate healthcare. Additionally, managing obesity and giving needed/timely support to obese people is a difficult responsibility for medical professionals and their loved ones. The need for caregivers is increasing with the increased number of individuals with obesity, particularly Hispanics. Our article summarizes the status of obesity, focusing on Hispanic populations, and we also highlight specific factors that contribute to obesity, including genetics, epigenetics, biological, physiological, and psychosocial factors, medication and disease, environment, and socio-demographics. This article also reviews caregiver duties and challenges associated with caring for people with obesity.

Secreted Protein Acidic and Rich in Cysteine (SPARC) to Manage Coronavirus Disease-2019 (COVID-19) Pandemic and the Post-COVID-19 Health Crisis

Coronavirus disease-2019 (COVID-19) has had and will have impacts on public health and health system expenses. Indeed, not only it has led to high numbers of confirmed COVID-19 cases and hospitalizations, but its consequences will remain even after the end of the COVID-19 crisis. Therefore, therapeutic options are required to both tackle the COVID-19 crisis and manage its consequences during the post COVID-19 era. Secreted protein acidic and rich in cysteine (SPARC) is a biomolecule that is associated with various properties and functions that situate it as a candidate which may be used to prevent, treat and manage COVID-19 as well as the post-COVID-19-era health problems. This paper highlights how SPARC could be of such therapeutic use.

Physical Activity and Its Association With Body Mass Index: A Cross-Sectional Analysis in Middle-Aged Adults From 4 Sub-Saharan African Countries

BACKGROUND

This study aimed to explore association of self-reported physical activity domains of work, leisure, and transport-related physical activity and body mass index (BMI) in 9388 adult men and women from the Africa-Wits-INDEPTH partnership for Genomic (AWI-Gen) study in Africa. Africa-Wits-INDEPTH partnership for Genomic is a large, population-based cross-sectional cohort with participants from 6 sites from rural and urban areas in 4 sub-Saharan African countries.

METHODS

A sex-stratified meta-analysis of cross-sectional data from men and women aged 29-82 years was used to assess the association of physical activity with BMI.

RESULTS

Overall, meeting physical activity guidelines of at least 150 minutes per week was associated with 0.82 kg/m2 lower BMI in men (β = -0.80 kg/m2; 95% confidence interval [CI], -1.14 to -0.47) and 0.68 kg/m2 lower BMI in women (β = -0.68 kg/m2; 95% CI, -1.03 to -0.33). Sex and site-specific differences were observed in the associations between physical activity domains and BMI. Among those who met physical activity guidelines, there was an inverse association between transport-related physical activity and BMI in men from Nanoro (Burkina Faso) (β = -0.79 kg/m2; 95% CI, -1.25 to -0.33) as well as work-related physical activity and BMI in Navrongo men (Ghana) (β = -0.76 kg/m2; 95% CI, -1.25 to -0.27) and Nanoro women (β = -0.90 kg/m2; 95% CI, -1.44 to -0.36).

CONCLUSIONS

Physical activity may be an effective strategy to curb rising obesity in Africa. More studies are needed to assess the impact of sex and geographic location-specific physical activity interventions on obesity.

Neuregulin 4 as a novel adipokine in energy metabolism

Adipose tissue has been shown to play a key role in energy metabolism and it has been shown to regulate metabolic homeostasis through the secretion of adipokines. Neuregulin 4 (Nrg4), a novel adipokine secreted mainly by brown adipose tissue (BAT), has recently been characterized as having an important effect on the regulation of energy homeostasis and glucolipid metabolism. Nrg4 can modulate BAT-related thermogenesis by increasing sympathetic innervation of adipose tissue and therefore has potential metabolic benefits. Nrg4 improves metabolic dysregulation in various metabolic diseases such as insulin resistance, obesity, non-alcoholic fatty liver disease, and diabetes through several mechanisms such as anti-inflammation, autophagy regulation, pro-angiogenesis, and lipid metabolism normalization. However, inconsistent findings are found regarding the effects of Nrg4 on metabolic diseases in clinical settings, and this heterogeneity needs to be further clarified by future studies. The potential metabolic protective effect of Nrg4 suggests that it may be a promising endocrine therapeutic target.

Drosophila exercise, an emerging model bridging the fields of exercise and aging in human

Exercise is one of the most effective treatments for the diseases of aging. In recent years, a growing number of researchers have used Drosophila melanogaster to study the broad benefits of regular exercise in aging individuals. With the widespread use of Drosophila exercise models and the upgrading of the Drosophila exercise apparatus, we should carefully examine the differential contribution of regular exercise in the aging process to facilitate more detailed quantitative measurements and assessment of the exercise phenotype. In this paper, we review some of the resources available for Drosophila exercise models. The focus is on the impact of regular exercise or exercise adaptation in the aging process in Drosophila and highlights the great potential and current challenges faced by this model in the field of anti-aging research.

Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O)

INTRODUCTION

Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O).

METHOD

Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity.

RESULTS

Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability.

STUDY 2

A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ²/df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged.

CONCLUSION

The EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive research.

A Combination of Aerobic Exercise at Fatmax and Low Resistance Training Increases Fat Oxidation and Maintains Muscle Mass, in Women Waiting for Bariatric Surgery

PURPOSE

There is no consensus on the best exercise recommendation for women affected by severe obesity while they are waiting for bariatric surgery. For this reason, the effects of a combination of aerobic exercise performed at the intensity at which maximal fat oxidation is reached (Fatmax) with low-intensity resistance training were studied.

MATERIALS AND METHODS

Twenty sedentary middle-aged Caucasian women (43.2 ± 7.5 years, BMI = 46.5 ± 5.9 kg·m^-2) were allocated to a control group (CG, n = 10) that followed solely the conventional preoperative care or to an experimental group (EG, n = 10) that, in addition, performed a 12-week individualized and supervised physical activity program (PAP) that combined aerobic training at Fatmax with low-intensity resistance training.

RESULTS

After the PAP, maximal fat oxidation during exercise increased in the EG (0.187 ± 0.068 vs 0.239 ± 0.080 g·min^-1, p = 0.025, pre vs. post, respectively), but resting fat oxidation did not (0.088 ± 0.034 vs 0.092 ± 0.029 g·min^-1, p = 0.685, pre vs. post, respectively). Additionally, the resting metabolic rate in the EG was also unchanged (1869 ± 406 vs. 1894 ± 336 kcal; p = 0.827, pre vs. post, respectively), probably because of the effects of resistance training on the maintenance of fat-free mass. No significant changes were observed in the CG.

CONCLUSION

A PAP that combines aerobic exercise at Fatmax with low resistance training may counteract some of the deleterious side effects of the standard presurgical care of women waiting for bariatric surgery and increase maximal fat oxidation during exercise.

Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial

BACKGROUND

In healthy people and people with nonspecific chronic spinal pain (nCSP) and/or insomnia, participation in physical activity on a regular basis has several physical and psychological health benefits. However, people with chronic conditions often tend to reduce physical activity participation which can lead to deconditioning over time. Currently, there are no known predictors for an (in)active lifestyle (before and after physical therapy treatment) in people with chronic spinal pain and comorbid insomnia.

OBJECTIVE

To examine predictors of pre-treatment moderate-to-vigorous physical activity (MVPA) and to examine determinants for a change in MVPA in response to 14-weeks of active physical therapy treatment in people with nonspecific chronic spinal pain (nCSP) and comorbid insomnia.

METHODS

Baseline data and post-treatment data were analyzed for 66 participants. A linear multiple regression analysis was conducted to examine which factors predict MVPA at baseline. Linear mixed-effects modeling was used to identify determinants for change in MVPA in response to an active physical therapy treatment.

RESULTS

Physical fatigue (b = -0.9; 95%CI: -1.59, -0.15), less limitations in functioning as a result of emotional problems (b = 0.1; 95%CI: 0.03, 0.10), mental fatigue (b = -1.0; 95%CI: -1.67, -0.43), lower general sleep quality (b= 0.7; 95%CI: 0.22, 1.17), and body mass index (b = -0.5; 95%CI: -0.93, -0.16) were significant predictors of baseline MVPA. The regression model explained 33.3% of the total variance in baseline MVPA. The change of MVPA in response to the treatment ranged from a decrease of 17.5 to an increase of 16.6 hours per week. No determinants for change in MVPA after treatment could be identified.

CONCLUSION

People with nCSP and comorbid insomnia are more likely to engage in MVPA if they report, at baseline, lower sleep quality, fewer limitations in functioning resulting from emotional problems, lower body mass index, as well as less physical and mental fatigue.

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.