How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement

Contemporary national and international guidelines on physical activity and sedentary behaviour for people living with chronic conditions, disability and advanced age: a scoping review

OBJECTIVES

Physical activity guidelines inform policy and practice in promoting healthier lifestyles. The WHO advocates for distinct recommendations for each country to address variation in needs, resources and context. Specific regional recommendations for three underactive populations facing unique barriers to movement are lacking-people with chronic conditions, disability and advanced age. We review which countries/regions provide specific physical activity guidelines for these populations to identify deficiencies in meeting WHO recommendations and inform future directions for guideline development.

DESIGN

Scoping review.

DATA SOURCES

OVID Medline, PubMed, Scopus, Embase, Web of Science, Google Scholar, ProQuest, CINAHL, Google searches, targeted websites.

ELIGIBILITY CRITERIA

Data sources were searched from database inception to September 2023 to identify community-facing physical activity guidelines at the national/international level for these populations. We recorded, summarised and analysed physical activity guideline recommendations extracted from published guideline documents, organised by population and country/region.

RESULTS

66 articles were identified, addressing 28 distinct countries/regions, including four international guidelines, published from 2009 to 2023. The WHO guidelines were adopted by 19 countries and the European Union. Across all regions, a lack of specific advice was identified for individuals with chronic conditions (46%), disability (46%) and advanced age (11%). Advice for chronic conditions and disability commonly replicated general adult population advice.

CONCLUSION

Many countries/regions do not produce physical activity guidelines specific to populations with chronic conditions and disability. As such, a large proportion of countries/regions failed to meet WHO recommendations, highlighting a lack of customised advice to address unique barriers faced by vulnerable populations.

Revised definition of obesity in Asian Indians living in India

AIM

The prevailing guidelines for obesity in Asian Indians, published in 2009, relied solely on body mass index (BMI) criteria. Recognizing the limitations of BMI in accurately diagnosing obesity and the emergence of new research revealing the association between generalized and abdominal adiposity in Asian Indians and early-onset co-morbid diseases, a comprehensive redefinition was needed.

METHOD

In a Delphi process focused on obesity in India, experts were invited via email to participate in five rounds. The survey questions were administered through Google Form to gather insights from the selected experts.

RESULTS

In Stage 1 Obesity, individuals exhibit increased adiposity (BMI>23 kg/m2) without discernible effects on organ functions or daily activities. Stage 2 Obesity denotes a more advanced state characterized by heightened adiposity (generalized and abdominal), impacting both physical and organ functions, resulting in functional limitations during day-to-day activities, and contributing to co-morbid diseases. The criteria for Stage 2 Obesity include a mandatory BMI exceeding 23 kg/m2 and at least one of the following: excess waist circumference or waist-to-height ratio. Additionally, the presence of one or more symptoms indicative of limitations in daily activities or one or more obesity-related comorbid conditions/diseases are needed to support the stage 2 obesity.

CONCLUSION

This refined framework seeks to enhance precision in identifying obesity and its associated health risks among Asian Indians living in India, and facilitation of rational management, and aligns with worldwide initiative of new definition of obesity.

Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement

ABSTRACT

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Potential Impact of Physical Activity on Measures of Well-Being and Quality of Life in People with Rare Diseases: A Nationwide Cross-Sectional Study in Italy

BACKGROUND

Rare diseases constitute a heterogeneous group of approximately 7000-8000 conditions, distinguished by their low prevalence. Collectively, they present a significant global health challenge, affecting millions of people worldwide. It is estimated that rare diseases affect approximately 10% of the global population, which places a significant burden on individuals, families, and society. It is, therefore, important to consider strategies to improve the overall well-being and quality of life of individuals with rare diseases. One potential avenue for exploration is the incorporation of physical activity (PA). The scope of this study was to ascertain whether PA has a positive impact on measures of well-being and to determine its potential to enhance the quality of life of these individuals.

METHODS

The data were collected via an online survey. The one-way ANOVA test for multiple groups and multivariate Poisson models were employed to identify the significant predictors of the outcomes of interest.

RESULTS

The protective effects of PA become evident with a minimum of six hours of activity per week. Our data confirm that the weekly hours devoted to PA can serve as a significant protective factor for QoL. The study also provided some insights into the motivations behind patients' engagement in PA. These included improving QoL and physical well-being, as well as the desire to interact socially, with the goal of meeting friends or making new acquaintances. Finally, for adults and older adults, engaging in PA can also be a way to control weight.

CONCLUSIONS

It is becoming increasingly clear that individuals with rare diseases stand to benefit greatly from PA, so it is only sensible to educate them on the advantages of an active lifestyle.

A CNN Model for Physical Activity Recognition and Energy Expenditure Estimation from an Eyeglass-Mounted Wearable Sensor

Metabolic syndrome poses a significant health challenge worldwide, prompting the need for comprehensive strategies integrating physical activity monitoring and energy expenditure. Wearable sensor devices have been used both for energy intake and energy expenditure (EE) estimation. Traditionally, sensors are attached to the hip or wrist. The primary aim of this research is to investigate the use of an eyeglass-mounted wearable energy intake sensor (Automatic Ingestion Monitor v2, AIM-2) for simultaneous recognition of physical activity (PAR) and estimation of steady-state EE as compared to a traditional hip-worn device. Study data were collected from six participants performing six structured activities, with the reference EE measured using indirect calorimetry (COSMED K5) and reported as metabolic equivalents of tasks (METs). Next, a novel deep convolutional neural network-based multitasking model (Multitasking-CNN) was developed for PAR and EE estimation. The Multitasking-CNN was trained with a two-step progressive training approach for higher accuracy, where in the first step the model for PAR was trained, and in the second step the model was fine-tuned for EE estimation. Finally, the performance of Multitasking-CNN on AIM-2 attached to eyeglasses was compared to the ActiGraph GT9X (AG) attached to the right hip. On the AIM-2 data, Multitasking-CNN achieved a maximum of 95% testing accuracy of PAR, a minimum of 0.59 METs mean square error (MSE), and 11% mean absolute percentage error (MAPE) in EE estimation. Conversely, on AG data, the Multitasking-CNN model achieved a maximum of 82% testing accuracy in PAR, a minimum of 0.73 METs MSE, and 13% MAPE in EE estimation. These results suggest the feasibility of using an eyeglass-mounted sensor for both PAR and EE estimation.

Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation

BACKGROUND

A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses.

OBJECTIVE

This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort.

METHODS

A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation.

RESULTS

The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251).

CONCLUSIONS

eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.

Effects of gastric bypass bariatric surgery on gut microbiota in patients with morbid obesity

The Western diet is associated with gastrointestinal dysbiosis, an active contributor to the pathophysiology of obesity and its comorbidities. Gastrointestinal dysbiosis is strongly linked to increased adiposity, low-grade inflammation, dyslipidaemia, and insulin resistance in individuals with morbid obesity. Bariatric bypass surgery remains the most effective treatment for achieving significant weight loss and alleviating obesity-related comorbidities. A growing body of evidence indicates that traditional Roux-en-Y Gastric Bypass (RYGB) improves the disrupted gut microbiota linked with obesity, potentially contributing to sustained weight loss and reduction of comorbidities. One Anastomosis Gastric Bypass (OAGB), a relatively new and technically simpler bariatric procedure, has shown both safety and efficacy in promoting weight loss and improving comorbidities. Few studies have investigated the impact of OAGB on gut microbiota. This review provides insights into the pathogenesis of obesity, current treatment strategies and our current understanding of the gut microbiota in health and disease, including modulating the gut microbiota as a promising and novel way to alleviate the burden of obesity and cardiometabolic conditions. By exploring the impact of gastric bypass surgery on gut microbiota-host interactions, we aim to shed light on this evolving field of research and uncover potential therapeutic targets for elevating outcomes in bariatric surgery.

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.

Association of accelerometer-measured physical activity, back static muscular endurance and abdominal obesity with radicular pain and non-specific low back pain

Low back pain (LBP) is the leading cause of disability worldwide and often associated with lifestyle factors. However, studies further examining the role of these lifestyle factors in non-specific low back pain in comparison with radicular pain are sparse. The aim of this cross sectional study was to investigate how diverse lifestyle factors are associated with LBP. The study population of 3385 middle aged adults with and without low back pain was drawn from a large Birth 1966 Cohort. Outcome measures were steps per day, abdominal obesity, physical activity and endurance of the back muscles. Back static muscular endurance, abdominal obesity and physical activity were measured by means of the Biering-Sørensen test, waist circumference and a wrist worn accelerometer, respectively. Logistic regression analysis was applied to estimate associations of back static muscular endurance, abdominal obesity and accelerometer-measured physical activity with non-specific low back pain and radicular pain. An additional 1000 steps per day were associated with 4% lower odds of having non-specific low back pain. Participants with abdominal obesity had 46% higher odds of having radicular pain, whereas increases of 10 s in back static muscular endurance and 10 min in daily vigorous physical activity were associated with 5% and 7% lower odds of having radicular pain, respectively. In this population-based study, non-specific low back pain and radicular pain were associated with different lifestyle and physical factors at midlife. Non-specific low back pain was associated only with the average daily number of steps, whereas abdominal obesity was the strongest determinant of radicular pain, followed by vigorous physical activity and back static muscular endurance. The findings of this study contribute to better understand the role of lifestyle factors in both non-specific low back pain and radicular pain. Future longitudinal studies are required to explore causality.

The complex pattern of the effects of prolonged frequent exercise on appetite control, and implications for obesity

From a public health perspective, much of the interest in the relationship between exercise and appetite rests on the implications for energy balance and obesity. Energy balance reflects a dynamic 2-way interaction between energy expenditure (EE) and energy intake (EI). Physical activity and exercise, and appetite are the behavioural components of EE and EI, respectively. Beyond EE, exercise is a powerful and complex physiological stimulus acting on several bodily systems. There are multiple effects of frequent and prolonged exercise on appetite which include inter alia an increase in fasting hunger, an enhancement of post-prandial satiety, a modulation of the hedonic responses to food and improvements in eating behaviour traits. These lead to variable adjustments in EI and in a reduction in the susceptibility to overconsumption. Frequent and prolonged physical activity and exercise behaviour can strengthen and sensitise the appetite control system, whilst physical inactivity and sedentariness (low level of EE) fails to downregulate EI and can permit overconsumption. Not all of the effects of exercise operate uniformly to drive appetite in the same direction. The complexity of the interaction between EE and EI means that the effects of prolonged exercise are characterised by substantial individual heterogeneity. This leads to variable effects on energy balance and body mass.

Impacto de los diferentes tipos de entrenamiento físico sobre la composición corporal en mujeres adultas con obesidad: una revisión bibliográfica

Introducción: La obesidad sigue siendo uno de los problemas más grandes de salud pública en todo el mundo. Se conoce que está asociada con una gran variedad de enfermedades; en mujeres obesas, aún se desconoce la forma idónea para realizar una adecuada prescripción física. Objetivo: revisar los tipos de entrenamientos físicos de ensayos controlados aleatorizados publicados en la base de datos PubMed entre los años 2015 a 2022 sobre los cambios en la composición corporal en mujeres adultas de 18 a 65 años con obesidad. Metodología: se utilizó a modo de filtro la “Herramienta de Evaluación de Calidad Validada para Estudios Cuantitativos”. Resultados: la búsqueda arrojó 586 artículos, de los cuales el 93.85% fueron eliminados; 6.14% pasaron por un filtro que dejó un total de 1.7%. Conclusión: en mujeres adultas con obesidad, se ha demostrado que todos los tipos de entrenamiento físico sirven para generar cambios en la composición corporal. Introduction: Obesity continues to be one of the biggest public health problems worldwide. It is known to be associated with a wide variety of diseases; in obese women, the ideal way to carry out an adequate physical prescription is still unknown. Objective: to review the types of physical training in randomized controlled trials published in the PubMed database between 2015 and 2022 on changes in body composition in adult women aged 18 to 65 with obesity. Methodology: the "Validated Quality Assessment Tool for Quantitative Studies" was used as a filter. Outcomes: the search yielded 586 articles, of which 93.85% were eliminated; 6.14% went through a filter that left a total of 1.7%. Conclusion: in adult women with obesity, it has been shown that all types of physical training serve to generate changes in body composition.

The effects of preventive aerobics mix on body composition in healthy adult women

The aim of this research was to determine the influence of a 12-week program of aerobics mix on the parameters of body composition in healthy adult women. The research has been performed in a sample of 64 women participants, and it is divided into two groups, an experimental group (E), made of 34 women participants (age 32 ± 1.8 years), and a control one (C), made of 30 women participants (age 33 ± 0.5 years). Their anthropometric and body composition were evaluated using the following respective parameters: body height, body weight, body fat percentage, muscle mass percentage, skinfold-back (KNL), skinfold-upper arm (KNN), skinfold-stomach (KNT), and skinfold-thigh (KNNK). After mix aerobics realization, among the women of the E group, there is a reduction of body mass by -2.5% and waist size by -3.39%, while muscle mass increased by 2.26%. With all skinfolds within the participants of the E group, there is a statistically important gained reduction of p < 0.05 at the final measuring, compared with the initial one (upper arm -21.10%, stomach -14.36%, back -20.58%, and upper leg -13.98%). The reduction of body mass percentage was -10.59%, and that of body mass index was -2.5%. Based on the gained results, it can be concluded that the mix program was efficient in the reduction of the subcutaneous fat tissue and visceral fat and also influential on the increase of muscle mass.

The prevalence and practice impact of weight bias among New Zealand registered dietitians

AIM

This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success.

METHODS

A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias. [Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client.

RESULTS

Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations.

CONCLUSIONS

Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia. Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.

Association between handgrip strength and metabolic syndrome: A meta-analysis and systematic review

BACKGROUND

Although muscle strength has been reported to be associated with metabolic syndrome (MetS), the association is still controversial. Therefore, the purpose of this meta-analysis was to identify the association between handgrip strength (HGS) and MetS.

METHODS

Original research studies involving HGS and MetS from database inception to 20 May 2022 were selected from PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang databases, and Chinese Biomedical Document Service System. The odds ratios (ORs) with 95% confidence intervals (CIs) of MetS for HGS were calculated using a random-effects model. A dose-response analysis was performed. Subgroup analysis and meta-regression were also conducted.

RESULTS

Thirty effect sizes (reported in 19 articles) with a total of 43,396 participants were included in this meta-analysis. All studies were considered to be of moderate-to-good quality. An inverse association between HGS (low vs. high) with MetS was shown (OR: 2.59, 95% CI: 2.06-3.25). Subgroup analyses demonstrated the pooled ORs of relative HGS (HGS/weight), relative HGS (HGS/BMI), and absolute HGS were 2.97 (95% CI: 2.37-3.71), 2.47 (95% CI: 1.08-5.63), and 1.34 (95% CI: 1.06-1.68), respectively. Dose-response analysis revealed a significant linear dose-response relationship between relative HGS (HGS/weight) and MetS in observational studies (0.1 HGS/weight: OR, 0.68; 95% CI: 0.62-0.75). Univariate meta-regression analysis indicated that country status, measuring tools of HGS, components of MetS, and diagnosed criteria of MetS explained 16.7%, 26.2%, 30.1%, and 42.3% of the tau-squared in the meta-regression, respectively.

CONCLUSION

The results of the current meta-analysis indicated that lower HGS is associated with a higher risk of MetS. A linear dose-response association between lower relative HGS (HGS/weight) and increased prevalence of MetS was found. Accordingly, a lower HGS is a significant predictor of MetS.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021276730].

The impact of high-intensity interval training on vascular function in adults: A systematic review and meta-analysis

Aim

We performed a systematic review and meta-analysis to investigate the effects of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) or with no exercise (CON) on vascular function in adults who were free of cardiometabolic diseases and those with cardiometabolic diseases.

Methods

A search across three electronic databases including Scopus, PubMed, and Web of Science was conducted through February 2022 to identify the randomized trials evaluating HIIT vs. MICT and/or CON on vascular function as measured using brachial artery flow-mediated dilation (FMD) in adults. Separate analyses were conducted for HIIT vs. MICT and/or CON to calculate weighted mean differences (WMD) and 95% confidence intervals (95% CIs) using random or fixed models.

Results

A total of 36 studies involving 1,437 participants who were either free of cardiometabolic diseases or had cardiometabolic diseases were included in the meta-analysis. HIIT effectively increased FMD when compared with MICT [1.59% (95% CI 0.87-2.31), p = 0.001] or CON [3.80% (95% CI 2.58-5.01), p = 0.001]. Subgroup analysis showed that HIIT increased FMD in participants with cardiovascular and metabolic diseases, but not in participants who were free of cardiometabolic diseases. In addition, HIIT effectively increased FMD regardless of age and body mass index.

Conclusion

We confirm that HIIT is effective for improving vascular function in individuals with metabolic disorders and cardiovascular diseases and has a superior effect compared to MICT, demonstrating time efficiency.

Systematic review registration

[https://www.crd.york.ac.uk/prospero], identifier [CRD42022320863].

A Positive Emotion-Focused Intervention to Increase Physical Activity After Bariatric Surgery: Protocol for a Pilot Randomized Controlled Trial

Background

Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement.

Objective

The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting.

Methods

The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology–motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures.

Results

This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention.

Conclusions

Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial.

Trial Registration

ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032

International Registered Report Identifier (IRRID)

PRR1-10.2196/39856

Physical Activity at School Recess: A Key Element in Balancing Social Disparities

BACKGROUND

Since children are generally not achieving desirable levels of physical activity (PA), schools can provide an opportunity to increase their active time. This study aimed to describe individual- and social-level variables associated with PA at school recess in a culturally diverse primary school.

METHODS

This observational cross-sectional study included 131 children attending primary school. PA data were measured via accelerometry during school recess and analyzed in relation to data on sociodemographics, anthropometrics, and PA outside school. Data were analyzed using generalized linear modeling and logistic regression.

FINDINGS

Girls were more sedentary and engaged in less moderate to vigorous physical activity (MVPA) than boys (p < .001), while older girls were less active than younger girls (p < .001). Also, non-Caucasian children were less sedentary (p < .001) and engaged in more MVPA (p = .007). Belonging to ethnic minorities was also associated with lower socioeconomic status, higher body mass index, and less PA outside of school and on weekends.

CONCLUSIONS

Girls (especially older girls) and children from lower socioeconomic contexts should be prioritized when promoting PA.

IMPLICATIONS FOR SCHOOL HEALTH POLICY

School recess can be used as an effective strategy aimed at increasing PA and reducing social inequalities.

Lacticaseibacillus rhamnosus HA-114 improves eating behaviors and mood-related factors in adults with overweight during weight loss: a randomized controlled trial

Background: Gut microbiota has emerged as a modifiable factor influencing obesity and metabolic diseases. Interventions targeting this microbial community could attenuate biological and psychological comorbidities of excess weight. Objective: Our aim was to determine if Lacticaseibacillus rhamnosus HA-114 supplementation accentuated beneficial impact of weight loss on metabolic and cognitive health. Methods: This 12-week randomized, double-blind, placebo-controlled trial assessed biological markers of energy metabolism, eating behaviors and mood-related factors in 152 adults with overweight receiving L. rhamnosus HA-114 supplementation or placebo, that were also on a dietary intervention inducing a controlled weight loss. Results: Although probiotic supplementation did not potentiate the reduction in body weight or fat mass, a significant decrease in plasma insulin, HOMA-IR, LDL-cholesterol and triglycerides was observed in the probiotic-supplemented group only. With respect to eating behaviors and mood-related factors, beneficial effects were either observed only in the group receiving probiotic supplementation or were significantly greater in this group, including decrease in binge eating tendencies, disinhibition and food-cravings. Conclusion: This study demonstrates the clinical relevance of probiotic supplementation to induce beneficial metabolic and psychological outcomes in individuals with overweight undergoing weight loss.Trial registration: ClinicalTrials.gov identifier: NCT02962583.

Obesity Subtyping: The Etiology, Prevention, and Management of Acquired versus Inherited Obese Phenotypes

The etiology of obesity is complex and idiosyncratic-with inherited, behavioral, and environmental factors determining the age and rate at which excessive adiposity develops. Moreover, the etiologic status of an obese phenotype (how and when it developed initially) strongly influences both the short-term response to intervention and long-term health trajectories. Nevertheless, current management strategies tend to be 'one-size-fits-all' protocols that fail to anticipate the heterogeneity of response generated by the etiologic status of each individual's phenotype. As a result, the efficacy of current lifestyle approaches varies from ineffective and potentially detrimental, to clinically successful; therefore, we posit that effective management strategies necessitate a personalized approach that incorporates the subtyping of obese phenotypes. Research shows that there are two broad etiologic subtypes: 'acquired' and 'inherited'. Acquired obesity denotes the development of excessive adiposity after puberty-and because the genesis of this subtype is behavioral, it is amenable to interventions based on diet and exercise. Conversely, inherited obesity subsumes all forms of excessive adiposity that are present at birth and develop prior to pubescence (pediatric and childhood). As the inherited phenotype is engendered in utero, this subtype has irreversible structural (anatomic) and physiologic (metabolic) perturbations that are not susceptible to intervention. As such, the most realizable outcome for many individuals with an inherited subtype will be a 'fit but fat' phenotype. Given that etiologic subtype strongly influences the effects of intervention and successful health management, the purpose of this 'perspective' article is to provide a concise overview of the differential development of acquired versus inherited obesity and offer insight into subtype-specific management.

Efficacy of Dapagliflozin Combined with Lifestyle Intervention in Obesity Control

Objective

To explore the best treatment of obesity in middle and old age.

Methods

80 obese patients in our hospital from January 2020 to December 2021 were randomly divided into the control group and the intervention group according to the numerical table method. The control group was treated with lifestyle intervention, while the intervention group was treated with dapagliflozin combined with lifestyle intervention. The effects of body weight, body mass index (BMI), waist circumference, and blood lipids (LDL, HDL, TC, and TG) were measured and compared. Anxiety and depression scores were assessed using the 2018 Revised Anxiety and Depression Scale.

Results

There were no significant differences in body weight, BMI, and waist circumference between the control group and the intervention group before treatment. After treatment, the weight, BMI, and waist circumference of the intervention group were lower than those of the control group, and the difference was statistically significant (P < 0.05). After treatment, LDL, TC, and TG in the two groups were decreased, and HDL was significantly increased (P < 0.05). After treatment, the blood lipid level in the intervention group was significantly lower than that in the control group (P < 0.05). Anxiety and depression symptoms improved in both groups, and there were no serious adverse effects.

Conclusion

Dapagliflozin in combination with a lifestyle intervention effectively and safely treats excess weight in middle-aged and older adults, reverses obesity-related markers, and improves psychological symptoms. Its curative effect is better than that of using lifestyle intervention alone.

Lifestyle Changes and Long-term Weight Gain in Women With and Without a History of Gestational Diabetes Mellitus: A Prospective Study of 54,062 Women in the Nurses' Health Study II

OBJECTIVE

We examined lifestyle factors with midlife weight change according to history of gestational diabetes mellitus (GDM) in a large longitudinal female cohort.

RESEARCH DESIGN AND METHODS

In the Nurses' Health Study II, we categorized changes in lifestyle within 4-year periods and estimated their associations with concurrent changes in body weight (kilograms) among parous women after age 40 years by GDM history status (N = 54,062; 5.3% with a history of GDM) for the following: diet quality (Alternate Healthy Eating Index [AHEI]), leisure-time physical activity (PA), alcohol consumption, and smoking status.

RESULTS

Over a median follow-up of 13 years, average 4-year weight gain was 1.10 and 1.33 kg for women with and without prior GDM, respectively. Women with improved diet quality had favorable 4-year weight change, particularly those with a history of GDM (AHEI change [95% CI] from low to high -2.97 kg [-4.34, -1.60] vs. -1.19 kg [-1.41, -0.96] for GDM vs. non-GDM, respectively; P heterogeneity = 0.04). Increasing PA was associated with weight maintenance for GDM women only (PA increase [95% CI] from low to high 0.26 kg [-0.25, 0.77] vs. 0.90 kg [0.80, 1.01] for GDM vs. non-GDM, respectively; P heterogeneity = 0.02). For both GDM and non-GDM women, weight change did not differ significantly with change in alcohol consumption, while women who quit smoking had significant weight gain (4.38 kg for GDM and 3.85 kg for non-GDM).

CONCLUSIONS

Improvements in diet quality and PA were related to less weight gain in midlife among parous women, and the benefit of such improvements on weight management was particularly pronounced among women with a history of GDM.

Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity.

METHODS

A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m² and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol).

RESULTS

A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness.

CONCLUSIONS

In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.

The association between steps per day and blood pressure in children

Lower levels of physical activity are associated with an increased overall cardiometabolic risk, as well as the risk or being overweight. It is difficult to determine the optimal level of physical activity that protects the needs of children and young people. Studies on the required number of steps, as well as approximating the daily volume of physical activity, are gaining increasing credibility in research and practice. Researchers propose a "rule" of ≥ 11,500 steps per day, for children and teenagers of both sexes. The aim of the study was to assess whether 11,500 steps a day is sufficient to maintain normal blood pressure among children and adolescents. 1002 children and adolescents aged 4–15 were included in the study. To assess physical activity, measured in the number of steps per day, the Actigraph accelerometer wGT3X-BT was used. The normal number of steps was defined as greater than or equal to 11,500 steps per day for children and teenagers, for both girls and boys. In the entire study group, a significantly lower risk of hypertension was observed when the number of steps was normal (OR is 0.45 and the upper confidence limit for OR is 0.71). The study confirmed the beneficial protective role of physical activity against hypertension in older children and adolescents. However, it should be emphasized that no such relationship has been demonstrated in the case of preschool children. The presented norms of the number of steps should be promoted to the wider community to make prevention of cardiovascular diseases even more effective.

Lifestyle Modification in the Management of Metabolic Syndrome: Statement From Korean Society of CardioMetabolic Syndrome (KSCMS)

Metabolic syndrome (MetS) is highly prevalent and is associated with worse cardiovascular outcome. Lifestyle modification is the most effective way to reduce the incidence of cardiovascular complications caused by MetS. Here, we would like to review the effects and specific methods of the 6 lifestyle modifications (weight control, smoking cessation, alcohol drinking in moderation, diet control, exercise and physical activity, and cognitive behavioral therapy) and control of blood pressure, dyslipidemia, and blood sugar based on evidence in the management of MetS.

With the recent rapid increase in obesity worldwide, metabolic syndrome (MetS) has gained significant importance. MetS is a cluster of obesity-related cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, high blood pressure and impaired glucose tolerance. MetS is highly prevalent and strongly associated with an increased risk of developing diabetes and cardiovascular disease, putting a great burden on human society. Therefore, it is very important to reduce MetS risk, which can improve patients’ cardiovascular prognosis. The primary and most effective strategy to control each component of MetS is lifestyle change such as losing body weight, keeping regular exercise, adopting a healthy diet, quitting smoking and alcohol drinking in moderation. Many studies have shown that lifestyle modification has improved all components of MetS, and reduces the incidence of diabetes and cardiovascular disease. Here, the Korean Society of CardioMetabolic Syndrome has summarized specific and practical methods of lifestyle modification in the management of MetS in the healthcare field.

Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis

BACKGROUND

High levels of moderate-to-vigorous intensity physical activity (MVPA) are strongly associated with sustained weight loss, however the majority of adults are unsuccessful in maintaining high levels of MVPA long-term. Our goal was to identify profiles based on exercise motives, and examine the association between motivational profile and longitudinal changes in MVPA during a weight loss intervention.

METHODS

Adults with overweight or obesity (n = 169, mean ± SE; age 39 ± 0.7 years, BMI 34.4 ± 0.3 kg/m2, 83% female) underwent an 18-month behavioral weight loss program, including 6 months of supervised exercise, followed by 6 months of unsupervised exercise. Participants self-reported behavioral regulations for exercise at baseline (BREQ-2). Latent profile analysis identified subgroups from external, introjected, identified, and intrinsic regulations measured at baseline. Mean differences in device-measured total MVPA were compared across motivational profiles at baseline, after 6 months of supervised exercise and after a subsequent 6 months of unsupervised exercise.

RESULTS

Three motivational profiles emerged: high autonomous (high identified and intrinsic, low external regulations; n = 52), high combined (high scores on all exercise regulations; n = 25), and moderate combined (moderate scores on all exercise regulations; n = 92). Motivational profile was not associated with baseline level of MVPA or the increase in MVPA over the 6-month supervised exercise intervention (high autonomous: 21 ± 6 min/d; high combined: 20 ± 9 min/d; moderate combined: 33 ± 5 min/d; overall P > 0.05). However, during the transition from supervised to unsupervised exercise, MVPA decreased, on average, within all three profiles, but the high autonomous profile demonstrated the least attenuation in MVPA (- 3 ± 6 min/d) compared to the moderate combined profile (- 20 ± 5 min/d; P = 0.043).

CONCLUSIONS

Results were in alignment with the Self-Determination Theory. Adults motivated by autonomous reasons (value benefits of exercise, intrinsic enjoyment) may be more likely to sustain increases in MVPA once support is removed, whereas participants with moderate-to-high scores on all types of exercise regulations may need additional long-term support in order to sustain initial increases in MVPA.

CLINICAL TRIAL REGISTRATION

NCT01985568. Registered 24 October 2013.

Physical activity in management of persons with obesity

Physical activity and exercise have many benefits in persons with obesity, helping with weight loss, body fat loss, abdominal visceral fat loss and possibly with weight maintenance after weight loss. The effect of exercise training (endurance or endurance plus resistance or high-intensity interval training) alone on weight loss as outcome appears relatively modest, amounting to only a few kg. However, endurance training during weight loss has been shown to increase V̇O₂max and resistance training during weight loss leads to lower loss in lean body mass and increased muscle strength. In addition, higher physical activity levels improve cardiovascular risk, whatever weight variations. Specifically, physical activity or exercise is part of lifestyle measures for prevention of type 2 diabetes and substantially helps with metabolic control in patients with type 2 diabetes. The importance of physical activity counselling and exercise prescription in the management strategy will depend on specific treatment objectives as defined for a given patient, including weight loss, prevention of weigh regain, prevention of cardio-metabolic comorbidities, lean body mass preservation but also improvement in quality of life or development of social links. The 5 A's strategy consisting in: Ask, Assess, Advise, Agree, Assist (or Arrange) appears well adapted in this setting. Professionals need to be aware of the many barriers patients with obesity may meet on their way to increase habitual physical activity as specific solutions should be proposed. A major challenge is how to improve adherence to new physical activity habits over time.

The Relation of Body Mass Index to Muscular Viscoelastic Properties in Normal and Overweight Individuals

Background: The body mass index (BMI) is closely related to fat tissue, which may have direct or indirect effects on muscle function. Previous studies have evaluated BMI and muscle viscoelastic properties in vivo in older people or individual sexes; however, the relationship between BMI and muscular viscoelastic properties is still unknown. Aims: The purpose of this study was to determine the correlation of BMI with muscular viscoelastic properties, and to compare these properties in a young sedentary population with normal and overweight individuals. Methods: A total of 172 healthy sedentary individuals (mean age, 26.00 ± 5.45 years) were categorized by sex (male and female) and BMI classification (normal (BMI, 18.50-24.99 kg/m²), overweight (BMI = 25.00-29.99 kg/m²)). Body weight was evaluated using an electronic scale, while height was measured using a standard stadiometer. BMI was calculated by dividing the weight in kilograms by the square of height in meters. The viscoelastic properties (tone, stiffness, and elasticity) of the biceps brachii (BB) and biceps femoris (BF) muscles were measured bilaterally using the MyotonPRO device at rest. Results: The bilateral BF tone and stiffness, right BB stiffness, and elasticity showed weak correlations with BMI in all participants. Furthermore, the bilateral BF tone and stiffness, right BB stiffness and elasticity, and left BB stiffness were weakly positively correlated with male sex. Only the right BB elasticity was weakly positively correlated with BMI in females (p < 0.05). No correlation with BMI was determined for other viscoelastic properties (p > 0.05). The overweight group showed increased bilateral BF stiffness and tone, right BB stiffness, and reduced bilateral BB elasticity compared to the normal-weight group (p < 0.05), while other viscoelastic properties were similar (p > 0.05). Greater bilateral BB tone, BF tone and stiffness, and lower BF elasticity were observed in males than in females (p < 0.05), but other viscoelastic properties were not significantly different (p < 0.05). No effect of BMI-sex interactions was found on viscoelastic properties (p > 0.05). Conclusions: The BB and BF viscoelastic properties were weakly correlated with BMI. Males showed greater muscle tone and stiffness, and lower elasticity. The overweight individuals showed increased stiffness and tone, particularly in lower extremities, and reduced elasticity in upper extremities. The effect of BMI-sex interactions on the viscoelastic properties was not clear. Higher BMI (increased mechanical load) might cause the human body to develop different muscular viscoelastic adaptations in the extremities.

Physical activity in the management of obesity in adults: A position statement from Exercise and Sport Science Australia

This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change.

Temporal patterns of physical activity in successful weight loss maintainers

BACKGROUND/OBJECTIVES

Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management.

METHODS

We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m²), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m²), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m²). PA was assessed during 7 consecutive days using the activPAL^TM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models.

RESULTS

Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05).

CONCLUSIONS

WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.

Physical Activity From Adolescence Through Midlife and Associations With Body Mass Index and Endometrial Cancer Risk

Background

Physical activity is associated with lower risk for endometrial cancer, but the extent to which the association is mediated by body mass index (BMI) in midlife is unclear. This study describes the physical activity-endometrial cancer association and whether BMI mediates this relationship.

Methods

Participants were 67 705 women in the National Institutes of Health-AARP Diet and Health Study (50-71 years) who recalled their physical activity patterns starting at age 15-18 years. We identified 5 long-term physical activity patterns between adolescence and cohort entry (ie, inactive, maintained low, maintained high, increasers, decreasers). We used Cox regression to assess the relationship between these patterns and midlife BMI and endometrial cancer, adjusting for covariates. Mediation analysis was used to estimate the proportion of the physical activity-endometrial cancer association that was mediated by midlife BMI.

Results

During an average 12.4 years of follow-up 1468 endometrial cancers occurred. Compared with long-term inactive women, women who maintained high or increased activity levels had a 19% to 26% lower risk for endometrial cancer (maintained high activity: hazard ratio = 0.81, 95% confidence interval [CI] = 0.67 to 0.98; increasers: hazard ratio = 0.74, 95% CI = 0.61 to 0.91). They also had a 50% to 77% lower risk for obesity in midlife (eg, maintained high activity: odds ratio for a BMI of 30-39.9 kg/m2 = 0.50, 95% CI = 0.46 to 0.55; and maintained high activity, odds ratio for a BMI of ≥40 kg/m2 = 0.32, 95% CI = 0.26 to 0.39). BMI was a statistically significant mediator accounting for 55.5% to 62.7% of the physical activity-endometrial cancer associations observed.

Conclusions

Both maintaining physical activity throughout adulthood and adopting activity later in adulthood can play a role in preventing obesity and lowering the risk for endometrial cancer.

Type of Physical Training and Selected Aspects of Psychological Functioning of Women with Obesity: A Randomised Trial

Objective: We conducted a prospective randomised trial to assess whether a specific type of regular physical training performed by women with obesity is related to obtaining specific psychological benefits. Methods: Forty-four women qualified for the study and were divided into two groups. The applied intervention consisted of regular three-month physical exercises in the form of endurance training (group A) or endurance strength training (group B). Initially, and after the completed intervention, we examined anthropometric measurements and the level of: stress (PSS-10), general self-esteem (SES), body self-report (BSQ–34, FRS), and behaviours associated with diet (TFEQ-18). Results: As a result of the intervention, both groups had significantly lower anthropometric parameters and FRS scores with regard to the current figure (gr. A:δ FRS CS −0.90 ± 0.83, p < 0.001; gr. B:δ FRS CS −0.41 ± 0.50, p = 0.01) and BSQ–34 results (gr. A:δ BSQ–34 −14.90 ± 13.5, p = 0.001; gr. B:δ BSQ–34 − 18.64 ± 25.4, p = 0.01). Additionally, an increase in cognitive restraint (δ TFEQ–18 CR1.65 ± 2.06, p = 0.01) and a decrease in emotional eating (δ TFEQ–18 EE −0.82 ± 1.28, p = 0.01) were observed in group B. There were no between-group differences in terms of the magnitude of changes achieved due to the intervention, except for asignificant improvement in the perception of their current figure (FRS) (δ FRSCS −0.90 ± 0.83, p = 0.03) in group A. Conclusions: Regular physical activity over a three-month period by women with obesity promotes the perception of their own body as slimmer and lowers body shape concerns. The change in body shape perception was more pronounced under the influence of endurance training than endurance strength training. Trial registration: ClinicalTrials.gov ID NCT04793451.

Exercise training in the management of overweight and obesity in adults: Synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group

There is a need for updated practice recommendations on exercise in the management of overweight and obesity in adults. We summarize the evidence provided by a series of seven systematic literature reviews performed by a group of experts from across Europe. The following recommendations with highest strength (Grade A) were derived. For loss in body weight, total fat, visceral fat, intra-hepatic fat, and for improvement in blood pressure, an exercise training program based on aerobic exercise at moderate intensity is preferentially advised. Expected weight loss is however on average not more than 2 to 3 kg. For preservation of lean mass during weight loss, an exercise training program based on resistance training at moderate-to-high intensity is advised. For improvement in insulin sensitivity and for increasing cardiorespiratory fitness, any type of exercise training (aerobic, resistance, and combined aerobic or resistance) or high-intensity interval training (after thorough assessment of cardiovascular risk and under supervision) can be advised. For increasing muscular fitness, an exercise training program based preferentially on resistance training alone or combined with aerobic training is advised. Other recommendations deal with the beneficial effects of exercise training programs on energy intake and appetite control, bariatric surgery outcomes, and quality of life and psychological outcomes in management of overweight and obesity.

Physical Activity, Weight Loss, and Weight Maintenance in the DiOGenes Multicenter Trial

In this secondary analysis of the DiOGenes study, we investigated whether physical activity (PA) contributes to diet-induced weight loss and helps to reduce subsequent regain. We also studied the associations of PA with changes in cardiometabolic variables. Adults with overweight were included and followed an 8-week low-calorie diet (LCD). When successful (>8% weight loss), participants were randomized to different ad libitum diet groups and were advised to maintain their weight loss over the 6-month intervention period. Body weight (BW), body composition, cardiometabolic variables and subjectively-assessed PA were measured at baseline, at the end of weight loss and at the end of the intervention. BW was reduced by the LCD (from 99.8 ± 16.7 to 88.4 ± 14.9 kg; P < 0.001). This reduction was maintained during the weight maintenance period (89.2 ± 16.0 kg). Total PA (sum score of the three subscales of the Baecke questionnaire) increased during the weight loss period (from 8.16 ± 0.83 to 8.39 ± 0.78; P < 0.001) and this increase was subsequently maintained (8.42 ± 0.90). We found no evidence that baseline PA predicted weight loss. However, a higher level of baseline PA predicted a larger weight-loss-induced improvement in total cholesterol, triglycerides, glucose and CRP, and in post-prandial insulin sensitivity (Matsuda index). Subsequent weight and fat mass maintenance were predicted by the post-weight loss level of PA and associated with changes in PA during the weight maintenance phase. In conclusion, despite the fact that higher baseline levels of PA did not predict more weight loss during the LCD, nor that an increase in PA during the LCD was associated with more weight loss, higher PA levels were associated with more improvements in several cardiometabolic variables. The positive effect of higher PA on weight loss maintenance seems in contrast to randomized controlled trials that have not been able to confirm a positive effect of exercise training programmes on weight loss maintenance. This analysis supports the notion that higher self-imposed levels of PA may improve the cardiometabolic risk profile during weight loss and help to maintain weight loss afterwards.

Cardiac rehabilitation in patients with diabetes

Cardiac rehabilitation is very important since diabetes is the set of metabolic diseases characterized by chronic hyperglycemia, with alterations in the metabolism of carbohydrates, fats and proteins as a consequence of defects in the secretion and action of insulin. When diabetes is related to cardiovascular complications, they are the main cause of death due to risk factors such as dyslipidemia, obesity and hyperglycemia, thus causing atherosclerotic changes in the vascular bed, increasing the risk of a fulminant event. The prevention of heart disease in diabetics includes preventive methods of heart disease along with that of diabetes, such as glycemic control, proper nutrition, continuing therapeutic education, physical activity, and antilipid medications, along with pharmacological measures including vasodilators, beta-blockers and antiplatelet agents, etc. We conducted a review of the literature to identify studies on diabetes, cardiovascular prevention, and cardiac complications in diabetic patients. We carry out multiple investigations in published bibliographic databases. A total of twenty-nine studies have been reviewed for this review in which 100% evidenced the favorable contribution of cardiac rehabilitation in diabetic patients. Six studies evaluated the different current contents in diabetes equivalent to 20.6%, fifteen (studies evaluated the cardiovascular risks in diabetic patients equivalent to 51.7% and eight evaluated the cardiovascular complications that occur in diabetic patients equivalent to 27.7%%. Therapeutic management of heart disease in diabetic patients is aimed at reducing cardiovascular risk, through pharmacological and non-pharmacological treatments. However, the weakest point of the treatment is the lack of adherence to the treatments. Physical exercise is an essential element, together with hypoglycemic and nutritional treatment in diabetes mellitus (DM), due to its usefulness in the control of diabetes and prevention of cardiovascular complications.

Role of CaMKII in the regulation of fatty acids and lipid metabolism

BACKGROUND & AIMS

Previous studies have reported the beneficial roles of the activation of calmodulin-dependent protein kinase (CaMK)II to many cellular functions associated with human health. This review aims at discussing its activation by exercise as well as its roles in the regulation of unsaturated, saturated, omega 3 fatty acids, and lipid metabolism.

METHODS

A wide literature search was conducted using online database such as 'PubMed', 'Google Scholar', 'Researcher', 'Scopus' and the website of World Health Organization (WHO) as well as Control Disease and Prevention (CDC). The criteria for the search were mainly lipid and fatty acid metabolism, diabetes, and metabolic syndrome (MetS). A total of ninety-seven articles were included in the review.

RESULTS

Calmodulin-dependent protein kinase activation by exercise is helpful in controlling membrane lipids related with type 2 diabetes and obesity. CaMKII regulates many health beneficial cellular functions in individuals who exercise compared with those who do not exercise. Regulation of lipid metabolism and fatty acids are crucial in the improvement of metabolic syndrome.

CONCLUSIONS

Approaches that involve CaMKII could be a new avenue for designing novel and effective therapeutic modalities in the treatment or better management of metabolic diseases such as type 2 diabetes and obesity.

Physical inactivity in healthy, obese, and diabetic adults in Germany: An analysis of related socio-demographic variables

BACKGROUND

Adults with diabetes or obesity are more likely to be physically inactive than healthy adults. Physical activity is essential in the management of both diseases, necessitating targeted interventions in these groups. This study analysed physical inactivity (defined as not taking part in leisure-time physical activity) in over 100,000 adults in Germany considering their body mass index and the presence of diabetes. Furthermore, the relationship between specific socio-demographic factors with physical inactivity was investigated, particularly focussing diabetic and obese people, to refine the identification of risk-groups for targeted interventions on physical activity promotion.

METHODS

Data from 13 population-based health surveys conducted in Germany from 1997 to 2018 were used. The relevant variables extracted from these datasets were merged and employed in the analyses. We included data from 129,886 individuals in the BMI analyses and 58,311 individuals in the diabetes analyses. Logistic regression analyses were performed to identify the importance of six socio-demographic variables (age, sex/gender, education, income, employment, and migration) for the risk of physical inactivity.

RESULTS

Obese and diabetic people reported a higher prevalence of physical inactivity than those who were not affected. Logistic regression analyses revealed advanced age, low education level, and low household income as risk factors for physical inactivity in all groups. A two-sided migration background and unemployment also indicated a higher probability of physical inactivity.

CONCLUSION

Similar socio-demographic barriers appear to be important determinants of physical inactivity, regardless of BMI status or the presence of diabetes. However, physical activity promoting interventions in obese and diabetic adults should consider the specific disease-related characteristics of these groups. A special need for target group specific physical activity programmes in adults from ethnic minorities or of advanced age was further identified.

A Randomized Trial Evaluating Exercise for the Prevention of Weight Regain

OBJECTIVE

This study aimed to evaluate the effectiveness of three levels of exercise on weight regain subsequent to clinically meaningful weight loss (WL).

METHODS

Adults with overweight or obesity (n = 298) initiated a 3-month behavioral WL intervention, which included reduced energy intake, increased exercise, and weekly behavioral counseling. Participants achieving ≥5% WL (n = 235) began a 12-month behavioral WL maintenance intervention and were randomized to 150 min/wk (n = 76), 225 min/wk (n = 80), or 300 min/wk (n = 79) of partially supervised moderate-to-vigorous-intensity exercise.

RESULTS

Participants randomized to 150, 225, and 300 minutes of exercise completed 129 ± 30, 153 ± 49 and 179 ± 62 min/wk of exercise (supervised + unsupervised), respectively. Mean WL at 3 months (9.5 ± 3.1 kg) was similar across randomized groups (P = 0.68). Weight change across 12 months was 1.1 ± 6.5 kg, 3.2 ± 5.7 kg, and 2.8 ± 6.9 kg in the 150, 225, and 300 min/wk groups, respectively. Intent-to-treat analysis revealed no significant overall trend across the three treatment groups (P = 0.09), effects for group (P = 0.08), or sex (P = 0.21).

CONCLUSIONS

This study found no evidence for an association between the volume of moderate-to-vigorous-intensity exercise and weight regain across 12 months following clinically relevant WL. Further, results suggest that exercise volumes lower than those currently recommended for WL maintenance, when completed in conjunction with a behavioral weight-maintenance intervention, may minimize weight regain over 12 months.

Genetic Determinants of the Effects of Training on Muscle and Adipose Tissue Homeostasis in Obesity Associated with Lymphedema

It is widely accepted that metabolic changes associated with training are influenced by a person's genetic background. In this review, we explore the polymorphisms underlying interindividual variability in response to training of weight loss and muscle mass increase in obese individuals, with or without lymphedema, and in normal-weight subjects. We searched PubMed for articles in English published up to May 2019 using the following keywords: (((physical training[Title/Abstract] OR sport activity[Title/Abstract]) AND predisposition[Title/Abstract]) AND polymorphism [Title/Abstract]). We identified 38 single-nucleotide polymorphisms that may modulate the genetic adaptive response to training. The identification of genetic marker(s) that improve the beneficial effects of training may in perspective make it possible to assess training programs, which in combination with dietary intervention can optimize body weight reduction in obese subjects, with or without lymphedema. This is particularly important for patients with lymphedema because obesity can worsen the clinical status, and therefore, a personalized approach that could reduce obesity would be fundamental in the clinical management of lymphedema.

Effect of Health Education on Healthy Nutrition and Physical Activity among Female Teachers Aged 40-60 Years in Asmara, Eritrea: A Quasiexperimental Study

BACKGROUND

Middle age is a period in women's life where many changes occur in their bodies due to the decline of gonadotropins. As a result, they face various vasomotor, psychological, and somatic symptoms. Moreover, chronic illness such as diabetes, hypertension, heart diseases, and osteoporosis are prevalent at this time. Healthy nutrition and physical activity are effective factors to reduce the problems of menopause faced during middle age.

OBJECTIVE

This study aimed at assessing the effect of health education on healthy nutrition and physical activity among 40-60-year-old female teachers in elementary, junior, and secondary schools of Asmara.

METHOD

A quasiexperimental design was used in this study. The data were collected from 99 middle-age female teachers who were selected by stratified random sampling. The intervention was conducted using lecture, brochure, and group discussion for a total of 3 hours. Data on physical activity and healthy nutrition were collecting using HPLP- II subscales physical activity and nutrition. Sociodemographic data were collected using a predesigned questionnaire. The effect of educational training at preintervention and postintervention was evaluated by the paired t-test and factorial mixed ANOVA using SPSS (version 22).

RESULTS

The mean score of practicing healthy diet and physical activity at preintervention and postintervention was 27/44 (SD = 4.20) and 31/44 (SD = 5.36), respectively. A significant difference in the scores of practicing healthy diet and physical activity was observed after the educational intervention (MD = 4.06, 95% CI 2.95-5.17, p < 0.0001). The effectiveness of health education was seen across the categories of age, educational level, and occupational level where none of them showed significant interaction, displaying similar effect of educational intervention across all categories of the demographic variables.

CONCLUSION

The structured educational intervention was beneficial for the studied women in changing their practice on healthy nutrition and physical activity.

Multicomponent Exercise Training Combined with Nutritional Counselling Improves Physical Function, Biochemical and Anthropometric Profiles in Obese Children: A Pilot Study

Aerobics or strength exercise plus diet interventions have been shown to counteract childhood obesity. However, little is known with regard to periodized multicomponent exercise interventions combined with nutritional counselling, which might be less demanding but more enjoyable and respectful of children and adolescents’ nature. In order to analyze the impact of such a multimodal approach, 18 obese children (10.8 ± 1.6 years; 63% females; z Body Mass Index 3 ± 0.4) trained for 60 min, twice weekly and were measured for body composition, biochemical parameters and physical function. We found that 16 weeks of multimodal intervention (14 of training), based on fun-type skill-learning physical activities and physical conditioning with challenging circuits and games, together with nutritional counselling, led to an attendance > 80%, with significant overall health improvement. Body composition was enhanced (p < 0.01 for z BMI, mid-upper-arm-circumference, waist-to-height ratio, tricipital and subscapular skinfolds, body-fat % by Slaughter equation and Dual energy X-ray absorptiometry body fat% and trunk fat%), as well as metabolic profile (LDL cholesterol, gamma-glutamyl transferase , alanine aminotransferase ; p < 0.05), homeostatic model assessment of insulin resistance (HOMA-IR; p < 0.05) and inflammatory response (C-Reactive Protein; p < 0.05). Physical fitness was also improved (p < 0.01) through better cardiovascular test scores and fundamental movement patterns (Functional Movement Screen-7, FMS-4). Tailoring multimodal supervised strategies ensured attendance, active participation and enjoyment, compensating for the lack of strict caloric restrictions and the low volume and training frequency compared to the exercise prescription guidelines for obesity. Nutritional counselling reinforced exercise benefits and turned the intervention into a powerful educational strategy. Teamwork and professionals’ specificity may also be key factors.

The Role of Exercise in Patients with Obesity and Hypertension

PURPOSE OF REVIEW

This review sought to evaluate the role of exercise in patients with obesity and comorbid hypertension, with a focus on contemporary literature (since January 2015).

RECENT FINDINGS

No reviews have included patients classified with both obesity and hypertension and there is a paucity of randomised controlled trials examining the benefits of exercise in this population. Moreover, just one of 19 reviews examining the role of exercise on blood pressure included studies that met pre-defined inclusion criterion for hypertension, although seven conducted subgroup analyses stratified by mean baseline blood pressure. These demonstrated significantly larger reductions in blood pressure in hypertensive than pre-hypertensive and normotensive samples. There is a significant research-practice gap for understanding and influencing the role of exercise for patients with obesity and hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with obesity and hypertension.

Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss-a Retrospective Study

BACKGROUND

The aim of the study was to compare physical activity (PA) in patients who had undergone massive weight loss (MWL), before and after body contouring procedures.

METHODS

All patients undergoing body contouring surgery after MWL between 2007 and 2017 with a minimum follow-up of 6 months after the last procedure were included in this retrospective study. Excluded were those with a body mass index > 35 kg/m² and those with comorbidities leading to impaired PA. Quality of life (QOL) was assessed using the Moorehead-Ardelt QOL Questionnaire II. Evaluation of PA was obtained with the International Physical Activity Questionnaire (IPAQ) short form and the Freiburg PA Questionnaire. Functional impairment during exercise was analyzed using a self-designed functional impairment score (FIS).

RESULTS

In the 45 patients completing the survey (37 female, 8 male), an improvement in QOL (p < 0.001) and PA scored by the IPAQ (p = 0.017) was found. The Freiburg PA Questionnaire showed no difference in PA before and after body contouring surgery (p = 0,274). Furthermore, scores of the FIS indicated a decrease of functional impairment during physical activity after body contouring surgery (p < 0.001).

CONCLUSION

Body contouring improves QOL and PA in patients after massive weight loss. The results of our study confirm the important role of plastic surgery in the treatment and maintenance of health of patients with former obesity.

Not just studies, but fitness can also get you the intelligence and the grades!!

Objectives Physical fitness in children and adolescents determines their health status and predicts if they are prone to co-morbidities that may extend in adulthood. The initial literature on the benefits of being physically fit was limited to the musculoskeletal and cardio-respiratory systems. The recent trends have shown that physical fitness has an effect on the neurological system as well. Considering physical inactivity to be a problem in today's world and the growing evidences on physical fitness being related to cognition and academic performance, there is a need to explore more on these relationships. Thus, this study aims to find the correlation between physical fitness with academic performance and cognitive functions in adolescent urban school children. Hypothesis There is an association between physical fitness with academic performance and cognitive function. Methodology Three hundred and ninteen children were approached out of which 107 children consented for assessment. Their physical fitness was measured using the Progressive Aerobic Cardiovascular Endurance Run (PACER) test, the cognitive function was assessed using the Stroop test and the academic performance were taken from their final exam grades of 2019. Results A moderate positive correlation was found between physical fitness with cognitive function (r=0.528), with academic performance (r=0.545) and with self-reported physical activity per week (r=0.427). A fair negative correlation was found between physical fitness and Body Mass Index (BMI) (r=0.296). Conclusion This study confirms that physical fitness is positively associated with cognitive function, academic performance and self-reported physical activities and has a negative correlation with BMI.

Affect Improvements and Measurement Concordance Between a Subjective and an Accelerometric Estimate of Physical Activity

Abstract. Objectives: Physical activity (PA) positively influences several aspects of mental well-being including affect improvements. Yet, the fact that subjective and objective measures of PA often diverge challenges research on the relationship of PA and affect. Methods: Subjective (ecological momentary assessment, EMA) and objective (combined heart rate and accelerometric activity tracker) measures of PA alongside repeated ratings of positive and negative affects were obtained from 37 participants over 7 consecutive days. Results: Subjective and objective PA were significantly positively correlated. Affect improvements, that is, negative affect decrease as well as positive affect increase, were predicted by both subjective (EMA) and objective (activity tracker) data. Conclusions: Measurement concordance supports the validity of both assessment strategies. Affect improvements result from both subjective representations of one’s own activity as well as from physiological mechanisms of PA that one is not aware of, suggesting two independent routes to affect improvements.

Exercise in the treatment of childhood obesity

Changing lifestyles reduce the time spent by children on physical activity during the day. The result is an increasing frequency of childhood obesity, which has become one of the most common chronic diseases of childhood. Furthermore, the treatment of obesity in childhood is quite difficult, and the most common problem is non-compliance with obesity treatment. The path that will facilitate the adaptation to treatment comprises nutrition regulation and increased daily physical activity and psychological support. Diet alone leads to a significant reduction in both fat and non-fat body mass. However, adding exercise to dietary therapy improves weight loss by maintaining non-fat body mass. Even though exercise alone has little effect on weight loss, it provides a significant reduction in mortality. Moreover, regular physical exercise is also an important factor in regulating body composition during growth. However, changes in the child’s body during growth affect the motor power and performance, so it is necessary to plan the exercise according to the individual characteristics, age and sex of the child. Short-term frequent exercises are more entertaining and more accessible forms of exercise (dancing at home) for children, and enhance compliance with treatment. Starting treatment as soon as possible will also increase behavioral effectiveness and compliance. This paper focuses on the basics of exercise therapy, which is extremely beneficial for both healthy and obese children.

Impact of energy turnover on fat balance in healthy young men during energy balance, energetic restriction and overfeeding

Body weight control is thought to be improved when physical activity and energy intake are both high (high energy turnover (ET)). The aim of the present study was to investigate the short-term impact of ET on fat balance during zero energy balance (EB), energetic restriction (ER) and overfeeding (OF). In a randomised crossover study, nine healthy men (BMI: 23·0 (SD 2·1) kg/m2, 26·6 (SD 3·5) years) passed 3 × 3 d in a metabolic chamber: three levels of ET (low, medium and high; physical activity level = 1·3-1·4, 1·5-1·6 and 1·7-1·8) were performed at zero EB, ER and OF (100, 75 and 125 % of individual energy requirement). Different levels of ET were obtained by walking (4 km/h) on a treadmill (0, 165 and 330 min). Twenty-four-hour macronutrient oxidation and relative macronutrient balance (oxidation relative to intake) was calculated, and NEFA, 24-h insulin and catecholamine secretion were analysed as determinants of fat oxidation. During EB and OF, 24-h fat oxidation increased with higher ET. This resulted in a higher relative fat balance at medium ET (EB: +17 %, OF: +14 %) and high ET (EB: +23 %, OF: +17 %) compared with low ET (all P < 0·05). In contrast, ER led to a stimulation of 24-h fat oxidation irrespective of ET (no differences in relative fat balance between ET levels, P > 0·05). In conclusion, under highly controlled conditions, a higher ET improved relative fat balance in young healthy men during OF and EB compared with a sedentary state.

Appetite Control Is Improved by Acute Increases in Energy Turnover at Different Levels of Energy Balance

BACKGROUND

Weight control is hypothesized to be improved when physical activity and energy intake are both high [high energy turnover (ET)].

OBJECTIVE

The impact of three levels of ET on short-term appetite control is therefore investigated at fixed levels of energy balance.

DESIGN

In a randomized crossover trial, 16 healthy adults (25.1 ± 3.9 y of age; body mass index, 24.0 ± 3.2 kg/m2) spent three daylong protocols for four times in a metabolic chamber. Four conditions of energy balance (ad libitum energy intake, zero energy balance, -25% caloric restriction, and +25% overfeeding) were each performed at three levels of ET (PAL 1.3 low, 1.6 medium, and 1.8 high ET; by walking on a treadmill). Levels of appetite hormones ghrelin, GLP-1, and insulin (total area under the curve) were measured during 14 hours. Subjective appetite ratings were assessed by visual analog scales.

RESULTS

Compared with high ET, low ET led to decreased GLP-1 (at all energy balance conditions: P < 0.001) and increased ghrelin concentrations (caloric restriction and overfeeding: P < 0.001), which was consistent with higher feelings of hunger (zero energy balance: P < 0.001) and desire to eat (all energy balance conditions: P < 0.05) and a positive energy balance during ad libitum intake (+17.5%; P < 0.001).

CONCLUSION

Appetite is regulated more effectively at a high level of ET, whereas overeating and consequently weight gain are likely to occur at low levels of ET. In contrast to the prevailing concept of body weight control, the positive impact of physical activity is independent from burning up more calories and is explained by improved appetite sensations.