Non-exercise activity thermogenesis (NEAT): a component of total daily energy expenditure

High-level personal trainer perspective for industry practice and development in Serbia: a qualitative descriptive study

Personal trainers (PTs) play a pivotal role in promoting positive gym experiences, implementing effective weight loss strategies, and influencing healthier lifestyle choices. In Serbia, however, the absence of national accrediting bodies for standardised qualifications has led to a lack of formal recognition of exercise professionals. The views of personal training clients regarding their training practices and experiences have been explored previously. Building on this, the current study investigated the perspectives of high-level Serbian PTs, examining their professional developmental journeys, educational background, coaching philosophies, professional needs and experiences. The aim was to provide insights for educational institutions and other practitioners to adopt successful approaches that inspire lifelong exercise and promote positive lifestyle changes for increasingly sedentary populations. Using a snowball sampling method, we interviewed 12 high-level PTs, selected for their exceptional practice as recognised by their peers. The findings suggest a need for a shift from traditional, physical performance-focused approaches toward a more holistic model that incorporates psychosocial support and a care for the whole person, fostering an appreciation for the concept of physical literacy. Additionally, the study identifies critical gaps in PTs education and training, particularly concerning the lack of focus on behavior change models and inquiry-based skills essential for their future self-directed learning. These areas were highlighted as vital for continued professional development after formal qualifications are obtained. In conclusion, this research underlines the need for holistic training approaches to improve clients' physical and health outcomes. The study offers guidance to shape industry standards, foster accreditation systems, and start the debate on how best to continually support PTs during their careers. Such action is essential if the evolving personal training profession in Serbia is to be equipped with the tools needed to promote long-term client engagement and achieve the health benefits for the wider Serbian population.

The Human Energy Balance: Uncovering the Hidden Variables of Obesity

Obesity has emerged as a global epidemic, creating an increased burden of weight-related diseases and straining healthcare systems worldwide. While the fundamental principle of energy balance-caloric intake versus expenditure-remains central to weight regulation, real-world outcomes often deviate from simplistic predictions due to a multitude of physiological and environmental factors. Genetic predispositions, variations in basal metabolic rates, adaptive thermogenesis, physical activity, and nutrient losses via fecal and urinary excretion contribute to interindividual differences in energy homeostasis. Additionally, factors such as meal timing, macronutrient composition, gut microbiota dynamics, and diet-induced thermogenesis (DIT) further modulate energy utilization and metabolic efficiency. This Perspective explores key physiological determinants of the energy balance, while also highlighting the clinical significance of thrifty versus spendthrifty metabolic phenotypes. Key strategies for individualized weight management include precision calorimetry, circadian-aligned meal timing, the use of protein- and whole food diets to enhance DIT, and increases in non-exercise activity, as well as mild cold exposure and the use of thermogenic agents (e.g., capsaicin-like compounds) to stimulate brown adipose tissue activity. A comprehensive, personalized approach to obesity management that moves beyond restrictive caloric models is essential to achieving sustainable weight control and improving long-term metabolic health. Integrating these multifactorial insights into clinical practice will enhance obesity treatment strategies, fostering more effective and enduring interventions.

Reducing the urge to be physically active in patients with anorexia nervosa through virtual reality: protocol for a randomised-controlled feasibility trial

INTRODUCTION

Weight restoration is a primary goal in anorexia nervosa (AN) treatment. Recent studies suggest that addressing physical activity urges in patients with AN is a promising target to facilitate weight restoration. This trial will evaluate the feasibility of a virtual reality (VR)-based intervention as an add-on treatment to psychotherapy to improve activity urges and, consequently, initial treatment responses on core outcomes as targeted per AN treatment guidelines.

METHODS AND ANALYSIS

This single-centre feasibility trial adopts the single-blind, two-arm design and outcome measures of an intended full-scale randomised controlled trial (RCT) in order to establish that all necessary trial components work together as intended. It will evaluate feasibility as the primary endpoint and compare changes in ratings of the urge to be active between patients with AN randomly assigned to receiving VR intervention sessions and patients with AN in a control procedure. The feasibility of the full-scale RCT will depend on whether patients (1) will evaluate the experience as acceptable, (2) tolerate VR side effects and (3) will adhere to the intended intervention schedule. We define a set of three-tiered, formal progression criteria and employ a 'traffic light system' demarcating go (green), amend (amber) and stop (red) signals for advancing to the full-scale RCT.

ETHICS AND DISSEMINATION

The study was approved by the ethics committee of the Ruhr University Bochum's Medical Faculty at Campus East-Westphalia (AZ 2024-1296, 9 December 2024). Patients have to provide written consent before taking part in the study. The findings will be published with open access.

TRIAL REGISTRATION NUMBER

DRKS00035681, German Clinical Trials Register.

Adaptation and Psychometric Properties of the Behavioral Regulation in Exercise Questionnaire (BREQ-3) for Motivation Towards Incidental Physical Activity

This study aimed to adapt and analyze the psychometric properties of the Exercise Behavior Regulation Questionnaire (BREQ-3) for assessing motivation towards incidental physical activity. An instrumental study in a sample of 346 university students (21.1 ± 2.6 years, and 61.3% women) from various universities in Chile was undertaken. An adaptation of the BREQ-3 was applied, and a confirmatory factor analysis was performed using a robust weighted least squares estimator to assess the construct validity of the scale. Also, the convergent validity was evaluated using the average variance extracted, the discriminant validity using composite reliability, and the internal consistency using Cronbach's alpha (α) and McDonald's omega (ω) coefficients. The six-factor structure of intrinsic motivation (α = 0.96, ω = 0.96), integrated regulation (α = 0.95, ω = 0.95), identified regulation (α = 0.89, ω = 0.90), introjected regulation (α = 0.75, ω = 0.77), external regulation (α = 0.80, ω = 0.83), and amotivation (α = 0.75, ω = 0.79), with acceptable fit indices after eliminating items 8 and 11, was confirmed-χ2/df: 2.196, CFI: 0.99, TLI: 0.99, RMSEA: 0.059 (90% CI; 0.051-0.067). Adaptation of the BREQ-3 appears to be a reliable measure for assessing motivation in the context of incidental physical activity. Its use will contribute to understanding the explanatory mechanisms underlying this behavior.

Dietary Interventions and Physical Activity as Crucial Factors in the Prevention and Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and affects nearly 30% of the adult population and 10% of the pediatric population. It is estimated that this number will double by 2030. MASLD is one of the leading causes of hepatocellular carcinoma, cirrhosis, and liver transplantation, as well as a significant risk factor for cardiovascular disease and mortality. Due to the ever-increasing number of patients, the long-term asymptomatic course of the disease, serious complications, and lack of preventive programs, as well as insufficient awareness of the disease among patients and doctors themselves, MASLD is a growing interdisciplinary problem and a real challenge for modern medicine. The main cause of MASLD is an inappropriate lifestyle-inadequate nutrition and insufficient physical activity, which lead to various components of metabolic syndrome. Lifestyle changes-appropriate diet, weight reduction, and systematic physical activity-are also the basis for the prevention and treatment of MASLD. Hence, in recent years, so much importance has been attached to lifestyle medicine, to non-pharmacological treatment as prevention of lifestyle diseases. The narrative review presents possible therapeutic options for non-pharmacological management in the prevention and treatment of MASLD. The best documented and available diets used in MASLD were discussed, focusing on the benefits and drawbacks of the Mediterranean, high-protein, ketogenic, and intermittent fasting diets. In addition, the most recent recommendations regarding physical activity are summarized.

Conceptual and Evidence Update on Incidental Physical Activity: A Scoping Review of Experimental and Observational Studies

Promoting incidental physical activity (IPA) can help reduce sedentary lifestyles and physical inactivity levels in the population. However, there is heterogeneity in the definition of IPA, and studies have yet to synthesize the empirical findings on this topic. This review aimed to (1) Synthesize the definitions of the IPA used in the scientific literature, (2) Identify the behaviors part of the IPA, and (3) Synthesize the main findings on IPA. The review followed PRISMA guidelines. A systematic search was performed in July 2023, and an update was made in February 2024 in the CINAHL databases by EBSCOhost, Cochrane Library, Pubmed, ScienceDirect, Scopus, and Web of Science. The search phrase was ("incidental physical activity" OR "incidental physical activity of daily living" OR "incidental movement" OR "vigorous intermittent lifestyle physical activity" OR "VILPA" OR "physical activity of daily living"). Fifty-five studies were included, with non-experimental (40), experimental (12), qualitative studies (2), and mixed design (1). Ten different terms for IPA were identified, and a conceptual definition was included in 33 articles. Behaviors measured as part of the IPA were reported in 41 articles. These definitions describe unstructured, unplanned, and unintentional physical activities of daily living that are performed as a by-product of an activity with a different primary purpose during free or occupational time and without specific fitness, sport, or recreation goals. Include light and vigorous intensities ranging from short sessions of < 1 min to prolonged ones. They include home activities, self-care, gardening, occupation, active transportation, and walking. Furthermore, evidence on IPA suggests an association with a lower risk of all-cause mortality. The findings of this review contribute to the updated study of IPA. Advances in data processing methods are needed to capture the diversity of behaviors and deepen the understanding of IPA.

Acute Activity Urges Predict Lower Early Weight Gain During Inpatient Treatment for Anorexia Nervosa

Early weight gain is a primary goal in the treatment of anorexia nervosa (AN) and associated with more favorable discharge weights and clinical outcomes. Activity urges, that is, a motivational state to engage in activity, have been suspected to delay early weight gain, but their prognostic role remains barely explored. Here, we investigated whether acute (state-like) activity urges at treatment onset would predict within-person weight gain in patients with AN during the initial 2 weeks of inpatient treatment. Adults with AN from an inpatient unit (N = 53) completed an activity urges measure at treatment onset, and weight changes were monitored for the duration of their treatment. Regression analyses, controlling for admission body mass index and other patient variables (i.e., patient age and AN subtype), found that higher state activity urges were associated with lower initial weight gain. Mediation analyses showed that differences in early weight changes further linked higher activity urges at admission to lower discharge weights. An activity urge cutoff value of 2.76 for distinguishing between cases with optimal and suboptimal initial weight gain is proposed. We discuss potential mechanisms of the link between activity urges and early weight gain and the implications of activity urges as a prognostic factor for improving weight restoration during AN treatment.

Sum of Skinfold-Corrected Girths Correlates with Resting Energy Expenditure: Development of the NRGCO Equation

Our study aimed to validate existing equations and develop the new NRGCO equation to estimate resting energy expenditure (REE) in the Colombian population with moderate-to-high physical activity levels. Upon satisfying the inclusion criteria, a total of 86 (43F, 43M) healthy adults (mean [SD]: 27.5 [7.7] years; 67.0 [13.8] kg) were evaluated for anthropometric variables and REE by indirect calorimetry using wearable gas analyzers (COSMED K4 and K5). Significant positive correlations with REE were found for body mass (r = 0.65), body mass-to-waist (r = 0.58), arm flexed and tensed girth (r = 0.66), corrected thigh girth (r = 0.56), corrected calf girth (r = 0.61), and sum of breadths (∑3D, r = 0.59). As a novelty, this is the first time a significant correlation between REE and the sum of corrected girths (∑3CG, r = 0.63) is reported. Although existing equations such as Harris-Benedict (r = 0.63), Mifflin-St. Jeor (r = 0.67), and WHO (r = 0.64) showed moderate-to-high correlations with REE, the Bland-Altman analysis revealed significant bias (p < 0.05), indicating that these equations may not be valid for the Colombian population. Thus, participants were randomly distributed into either the equation development group (EDG, n = 71) or the validation group (VG, n = 15). A new model was created using body mass, sum of skinfolds (∑8S), corrected thigh, corrected calf, and age as predictors (r = 0.755, R2 = 0.570, RMSE = 268.41 kcal). The new NRGCO equation to estimate REE (kcal) is: 386.256 + (24.309 × BM) - (2.402 × ∑8S) - (21.346 × Corrected Thigh) + (38.629 × Corrected Calf) - (7.417 × Age). Additionally, a simpler model was identified through Bayesian analysis, including only body mass and ∑8S (r = 0.724, R2 = 0.525, RMSE = 282.16 kcal). Although external validation is needed, our validation resulted in a moderate correlation and concordance (bias = 91.5 kcal) between measured and estimated REE values using the new NRGCO equation.

The metabolic effects of habitual leg shaking: A randomized crossover trial

AIMS

The adverse effects of sedentary behavior on obesity and chronic diseases are well established. However, the prevalence of sedentary behavior has increased, with only a minority of individuals meeting the recommended physical activity guidelines. This study aimed to investigate whether habitual leg shaking, a behavior traditionally considered unfavorable, could serve as an effective strategy to improve energy metabolism.

MATERIALS AND METHODS

A randomized crossover study was conducted, involving 15 participants (mean [SD] age, 25.4 [3.6]; mean [SD] body mass index, 22 [3]; 7 women [46.7%]). The study design involved a randomized sequence of sitting and leg shaking conditions, with each condition lasting for 20 min. Energy expenditure, respiratory rate, oxygen saturation, and other relevant variables were measured during each condition.

RESULTS

Compared to sitting, leg shaking significantly increased total energy expenditure [1.088 kj/min, 95% confidence interval, 0.69-1.487 kj/min], primarily through elevated carbohydrate oxidation. The average metabolic equivalent during leg shaking exhibited a significant increase from 1.5 to 1.8. Leg shaking also raised respiratory rate, minute ventilation, and blood oxygen saturation levels, while having no obvious impact on heart rate or blood pressure. Electromyography data confirmed predominant activation of lower leg muscles and without increased muscle fatigue. Intriguingly, a significant correlation was observed between the increased energy expenditure and both the frequency of leg shaking and the muscle mass of the legs.

CONCLUSIONS

Our study provides evidence that habitual leg shaking can boost overall energy expenditure by approximately 16.3%. This simple and feasible approach offers a convenient way to enhance physical activity levels.

Using functional principal component analysis (FPCA) to quantify sitting patterns derived from wearable sensors

BACKGROUND

Sedentary behavior (SB) is a recognized risk factor for many chronic diseases. ActiGraph and activPAL are two commonly used wearable accelerometers in SB research. The former measures body movement and the latter measures body posture. The goal of the current study is to quantify the pattern and variation of movement (by ActiGraph activity counts) during activPAL-identified sitting events, and examine associations between patterns and health-related outcomes, such as systolic and diastolic blood pressure (SBP and DBP).

METHODS

The current study included 314 overweight postmenopausal women, who were instructed to wear an activPAL (at thigh) and ActiGraph (at waist) simultaneously for 24 hours a day for a week under free-living conditions. ActiGraph and activPAL data were processed to obtain minute-level time-series outputs. Multilevel functional principal component analysis (MFPCA) was applied to minute-level ActiGraph activity counts within activPAL-identified sitting bouts to investigate variation in movement while sitting across subjects and days. The multilevel approach accounted for the nesting of days within subjects.

RESULTS

At least 90% of the overall variation of activity counts was explained by two subject-level principal components (PC) and six day-level PCs, hence dramatically reducing the dimensions from the original minute-level scale. The first subject-level PC captured patterns of fluctuation in movement during sitting, whereas the second subject-level PC delineated variation in movement during different lengths of sitting bouts: shorter (< 30 minutes), medium (30 -39 minutes) or longer (> 39 minute). The first subject-level PC scores showed positive association with DBP (standardized β ^ : 2.041, standard error: 0.607, adjusted p = 0.007), which implied that lower activity counts (during sitting) were associated with higher DBP.

CONCLUSION

In this work we implemented MFPCA to identify variation in movement patterns during sitting bouts, and showed that these patterns were associated with cardiovascular health. Unlike existing methods, MFPCA does not require pre-specified cut-points to define activity intensity, and thus offers a novel powerful statistical tool to elucidate variation in SB patterns and health.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03473145; Registered 22 March 2018; https://clinicaltrials.gov/ct2/show/NCT03473145 ; International Registered Report Identifier (IRRID): DERR1-10.2196/28684.

Measurement of Energy Expenditure by Indirect Calorimetry with a Whole-Room Calorimeter

Energy plays a vital role in biological processes. To assess energy metabolism status in a large population cohort, the standard operating procedure for measuring energy expenditure measurement using a whole-room calorimeter was purposed in this study. This protocol illustrates the procedure and specific details for validating methanol burning and evaluating the metabolic status of volunteers. In metabolic status evaluation, the (1) O2 consumption, (2) CO2 production, (3) energy expenditure, and (4) respiratory exchange ratio were first measured at resting and provided as basic phenotype items in Human Phenotype Atlas. Besides, it includes the procedure and results for measuring exercise-related activity thermogenesis and evaluating the impact of environmental temperature on energy metabolism. These results demonstrate the broader utility of the whole-room calorimeter. The implementation of this protocol is expected to enhance the data comparability in Human Phenotype Atla and provide a valuable reference for metabolism-related studies.

Effects of public transportation use on non-exercise activity thermogenesis and health promotion: a mini-review

PURPOSE

Public transportation (PT) systems significantly shape urban mobility and have garnered attention owing to their potential impact on public health, particularly the promotion of physical activity. Beyond their transportation functions, PT systems also affect daily energy expenditure through non-exercise activity thermogenesis (NEAT). This mini-review surveys the existing literature to explore the effects of PT use on NEAT levels and subsequent health outcomes.

METHODS

A comprehensive literature search was conducted using the electronic databases PubMed, Google Scholar, and Web of Science. Keywords including "public transportation," "non-exercise activity thermogenesis," "physical activity," "health promotion," and related terms were used to identify relevant studies.

RESULTS

This review highlights the multifaceted relationship between PT use and health promotion, emphasizing the potential benefits and challenges of increasing NEAT through public transit utilization. Overall, the findings suggest that PT use contributes positively to NEAT levels, and thus improves health outcomes. However, the extent of this impact may vary depending on individual and contextual factors.

CONCLUSION

Interventions promoting active transportation modes, including public transit, hold promise for addressing sedentary behavior and fostering healthier lifestyles at the population level.

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.

Characteristics of non-exercise activity thermogenesis in male collegiate athletes under real-life conditions

Athletes experience high total energy expenditure; therefore, it is important to understand the characteristics of the components contributing to this expenditure. To date, few studies have examined particularly the volume and activity intensity of non-exercise activity thermogenesis (NEAT) in athletes compared to non-athletes under real-life conditions. This study aimed to determine the volume and intensity of NEAT in collegiate athletes. Highly trained Japanese male collegiate athletes (n = 21) and healthy sedentary male students (n = 12) participated in this study. All measurements were obtained during the athletes' regular training season under real-life conditions. NEAT was calculated using metabolic equivalent (MET) data using an accelerometer. The participants were asked to wear a validated triaxial accelerometer for 7 consecutive days. Physical activity intensity in NEAT was classified into sedentary (1.0-1.5 METs), light (1.6-2.9 METs), moderate (3.0-5.9 METs), and vigorous (≥6 METs) intensity. NEAT was significantly higher in athletes than in non-athletes (821 ± 185 kcal/day vs. 643 ± 164 kcal/day, p = 0.009). Although there was no significant difference in NEAT values relative to body weight (BW) between the groups (athletes: 10.5 ± 1.7 kcal/kg BW/day, non-athletes: 10.4 ± 2.2 kcal/kg BW/day, p = 0.939), NEAT to BW per hour was significantly higher in athletes than in non-athletes (0.81 ± 0.16 kcal/kg BW/h vs. 0.66 ± 0.12 kcal/kg BW/h, p = 0.013). Athletes spent less time in sedentary and light-intensity activities and more time in vigorous-intensity activities than non-athletes (p < 0.001, p = 0.019, and p = 0.030, respectively). Athletes expended more energy on vigorous- and moderate-intensity activities than non-athletes (p = 0.009 and p = 0.011, respectively). This study suggests that athletes' NEAT relative to BW per day is similar to that of non-athletes, but athletes spend less time on NEAT, which makes them more active in their daily lives when not exercising and sleeping.

Energy Expenditure in Free-Living Physical Activities and Sedentary Behaviors in Mexican Schoolchildren

Purpose: Metabolic equivalents for youth (METy) are derived using the estimated basal metabolic rate (BMR). However, is unknown whether this METy can be different when measured resting energy expenditure (REE) is used. The purposes of this article are to: (a) To determine whether there is equivalence between METy values calculated using measured REE (METy-mea) and METy using predicted BMR (METy-est). (b) To determine whether METy values of different activities are dependent on age, sex, and body composition. Methods: A cross-sectional study with a sample of 122 Mexican children (5-11 years old) was conducted. With indirect calorimetry, energy expenditure was measured at rest and during 16 sedentary- to vigorous-intensity physical activities. METy were obtained in two forms: METy-mea and METy-est. Equivalence testing was used to compare METy-mea and METy-est. To examine the individual-level agreement, Bland-Altman plots were graphed, and intra-class correlation coefficients (ICC) were calculated. Linear regression models were estimated having METy as the outcome. Results: For 15 activities, there was equivalence between METy-mea and METy-est (t > 2.05, p < 0.050). However, at the individual-level, for 7 activities the agreement between METy-eREE and METy-mREE was inadequate (ICC<0.75). In the Bland-Altman plots was evident that in 8 activities METy-est was biased compared to METy-mea, METy-est had more correlations with body mass index and body fat. Conclusions: In conclusion, at group-level, for most activities METy-mea and METy-est were equivalent. However, at the individual level, METy-est of many activities is not a valid estimate of METy-mea. METy-est of many physical activities were dependent on adiposity, which could be an artifact introduced when BMR is predicted.

Insights into Non-Exercise Physical Activity on Control of Body Mass: A Review with Practical Recommendations

Non-exercise physical activity (NEPA), also called unstructured or informal physical activity, refers to those daily activities that require movement of the human body without planning or strict control of the physical effort made. Due to new technologies and motorized transportation devices, the general population has significantly decreased its NEPA. This increase in sedentary lifestyles, physical inactivity, and excessive energy intake is considered a risk factor for obesity, non-communicable diseases (NCDs), and all-cause mortality. Searching in PubMed/MEDLINE and Web of Science databases, a narrative review of NEPA was carried out to address its conceptualization, promotion strategies for the general population, and monitoring through wearable devices. It is strongly recommended that governmental entities, health practitioners, and the construction industry adhere to "The Global Action Plan on Physical Activity 2018-2030: More Active People for a Healthier World" and implement different salutogenic urban strategies. These strategies aim to generate environments that motivate increases in NEPA, such as cycling and walking transportation (between 5000-12,500 steps per day), and the progression to physical exercise. There is a wide variety of electronic devices for personal use, such as accelerometers, smartphone apps, or "smart clothes", that allow for the monitoring of NEPA, some with a wide range of analysis variables contributing to the estimation of total daily energy expenditure and the promotion of healthy habits. In general, the further promotion and monitoring of NEPA is required as part of a strategy to promote healthy habits sustainable over time for the prevention and control of obesity and NCDs.

Do energy expenditure differences across work postures influence cognitive processing speed? A counter-balanced randomised cross-over trial

BACKGROUND

Anecdotal evidence links occupational sedentary behaviour, low energy expenditure (EE) and cognitive dysfunction. Nevertheless, EE across different work postures including active workstations remains unclear and its influence on cognitive processing speed is yet to be established.

OBJECTIVE

We aimed to investigate differences in EE across various work postures and its influence on cognitive processing speed.

METHODS

Sixteen desk-based employees performed simulated work tasks (typing, reading and cognitive tasks) in three different work positions (sitting, standing, and walking) in three different days. EE was measured for three days consecutively for 30-minutes in three simulated working postures using indirect calorimetry. Cognitive processing speed was assessed through computer-based choice reaction times during each work posture. The outcome variables of interest (EE, reaction times and accuracy) were compared between three work postures using repeated measures ANOVA and Pearson correlation.

RESULTS

EE in walking posture was higher (5.57±0.45 Kcal) than sitting (1.07±0.12 Kcal) and standing (1.88±0.42 Kcal). Total EE was significantly higher in walking than standing (35.17±6.86 Kcal) and sitting postures (41.37±8.46 Kcal). We did not find any significant differences in cognitive processing speed between different work postures except within standing work condition (60.22±13.97 ms). Accuracy was found to be reduced in walking compared to sitting (0.76±0.83%) and standing (0.43±0.09%) but not reached significance.

CONCLUSION

Although significant differences in EE were observed between work postures, walking or standing at work did not affect the cognitive processing speed.

Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of 30 common obesity myths, misunderstandings, and/or oversimplifications.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS discusses 30 common obesity myths, misunderstandings, and/or oversimplifications, utilizing referenced scientific publications such as the integrative use of other published OMA CPSs to help explain the applicable physiology/pathophysiology.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on 30 common obesity myths, misunderstandings, and/or oversimplifications is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of the underlying science may assist the obesity medicine clinician improve the care of patients with obesity.

Association between sitting/lying down, standing, walking time and number of steps per day with the hormonal profile and resting energy expenditure of women with obesity living in a low-income region

Reducing sedentary behaviour (SB) and increasing physical activity (PA) by sitting less and standing/walking more is advised to prevent chronic diseases. However, the mechanisms underlying this recommendation are not well established, especially in individuals with obesity living in low-income regions. The present study evaluated whether there are associations between PA indicators (PAI - standing time, walking time and the number of steps/d) and SB indicators (SBI - sitting/lying down time) with the hormonal profile and resting energy expenditure (REE) of adult women living in a low-income region. This is a cross-sectional study. We collected data on hormones (insulin resistance, leptin and thyroid axis), body composition (tetrapolar bioimpedance), REE (indirect calorimetry), and PAI and SBI (triaxial accelerometers, ActivPAL). Multivariable linear models adjusting for age and fat-free mass were performed. Fifty-eight women (mean age of 31 years and BMI of 33 kg/m²) were included. The mean sitting/lying down time and standing time were 16·08 and 5·52 h/d, respectively. Sitting/lying down time showed a direct association with free thyroxine (FT₄) (β = 0·56 ng/dl; 95 % CI = -1·10, -0·02). Standing time showed a direct association with FT₄ (β = 0·75 ng/dl; 95 % CI = 0·01; 1·48) and inverse association with free triiodothyronine (β = -2·83 pg/ml 95 % CI = -5·56, -0·10). There were no associations between PAI and SBI with the REE, insulin resistance, leptin and thyroid-stimulating hormone. Thus, decreased SB is associated with thyroid hormones levels but not with REE, insulin resistance or leptin in women with obesity living in low-income regions.

The Role of Physical Activity in Long-term Weight Loss: 36-month Results From a Randomized Controlled Trial

BACKGROUND

Physical activity (PA) may promote long-term weight loss, but facilitating high levels of PA in behavioral weight loss programs is challenging.

PURPOSE

This study reports the 36-month follow-up of a behavioral weight loss trial that tested the efficacy of increasing the emphasis on PA during treatment and using traditional or acceptance-based therapy (ABT) for this purpose. We also examined the extent to which long-term weight loss differed by PA pattern and tested if individual differences in eating behavior moderated this relationship.

METHODS

Participants (N = 320) were randomized to (1) standard behavioral weight loss treatment (BT), (2) BT with a focus on PA, or (3) ABT with a focus on PA. Weight loss and PA were measured at 24- and 36-month follow-up.

RESULTS

There were no differences between conditions in weight loss or PA at 24 or 36 months. Participants consistently engaging in high PA experienced the greatest weight losses. The positive impact of PA on weight loss was more pronounced among those with low emotional eating and those who believed that exercise did not affect their appetite.

CONCLUSIONS

Findings emphasize the difficulty of improving long-term PA among adults with overweight/obesity beyond what standard behavioral weight loss treatment achieves. This study highlights the need to develop new PA treatment strategies, and suggests that ABT for weight loss may be more effective when applied to eating behavior versus PA. Results also demonstrate the importance of addressing problematic eating behavior and cognitions to fully realize the benefits of PA for weight loss.

CLINICAL TRIAL INFORMATION

ClinicalTrials.gov identifier: NCT02363010.

Effects of gradient and age on energy expenditure and fat metabolism during aerobic exercise at equal intensity in women

[Purpose]

This study aimed to investigate the effects of gradient and age on energy expenditure and fat metabolism during aerobic exercise at equal intensity in women.

[Methods]

Thirty women in their twenties (n=15) and fifties (n=15) were enrolled. All subjects performed aerobic exercise on a treadmill for 10 min at 0% and 6% gradient repeatedly to elicit 50%, 60%, and 70% VO₂max.

[Results]

Energy expenditure and fat oxidation were higher during aerobic exercise at 6% of the gradient than at 0%, and there was no significant difference in carbohydrate oxidation in any age group.

[Conclusion]

Aerobic exercise at a 6% gradient was more favorable for fat oxidation than a 0% gradient in all age groups. In particular, in the case of women in their fifties, walking on a gradient of 6%, which is favorable for increasing fat oxidation, was more effective than walking on flat ground for preventing and reducing obesity. However, to examine the difference in fat oxidation among exercise intensities more accurately, exercise performed for longer than 30 min is required. Follow-up studies are required to investigate the effect of various gradients on physiological and metabolic characteristics when carrying out aerobic exercises for more than 30 min.

Obesity history, physical exam, laboratory, body composition, and energy expenditure: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is intended to provide clinicians an overview of the clinical and diagnostic evaluation of patients with pre-obesity/obesity.

Methods

The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS outlines important components of medical, dietary, and physical activity history as well as physical exams, with a focus on specific aspects unique to managing patients with pre-obesity or obesity. Patients with pre-obesity/obesity benefit from the same preventive care and general laboratory testing as those without an increase in body fat. In addition, patients with pre-obesity/obesity may benefit from adiposity-specific diagnostic testing - both generally and individually - according to patient presentation and clinical judgment. Body composition testing, such as dual energy x-ray absorptiometry, bioelectrical impedance, and other measures, each have their own advantages and disadvantages. Some patients in clinical research, and perhaps even clinical practice, may benefit from an assessment of energy expenditure. This can be achieved by several methods including direct calorimetry, indirect calorimetry, doubly labeled water, or estimated by equations. Finally, a unifying theme regarding the etiology of pre-obesity/obesity and effectiveness of treatments of obesity centers on the role of biologic and behavior efficiencies and inefficiencies, with efficiencies more often associated with increases in fat mass and inefficiencies more often associated with decreases in fat mass.

Conclusion

The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on History, Physical Exam, Body Composition and Energy Expenditure is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity.

Nutrition and physical activity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity principles applicable to the care of patients with increased body fat, especially those with adverse fat mass and adiposopathic metabolic consequences.

Methods

The scientific information and clinical guidance is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA CPS on Nutrition and Physical Activity provides basic clinical information regarding carbohydrates, proteins, fats (including trans fats, saturated fats, polyunsaturated fats, and monounsaturated fats), general principles of healthful nutrition, nutritional factors associated with improved health outcomes, and food labels. Included are the clinical implications of isocaloric substitution of refined carbohydrates with saturated fats and vice-versa, as well as definitions of low-calorie, very low-calorie, carbohydrate-restricted, and fat-restricted dietary intakes. Specific dietary plans discussed include carbohydrate-restricted diets, fat-restricted diets, very low-calorie diets, the Mediterranean diet, Therapeutic Lifestyle diet, Dietary Approaches to Stop Hypertension (DASH), ketogenic (modified Atkins) diet, Ornish diet, Paleo diet, vegetarian or vegan diet (whole food/plant-based), intermittent fasting/time restricted feeding, and commercial diet programs. This clinical practice statement also examines the health benefits of physical activity and provides practical pre-exercise medical evaluation guidance as well as suggestions regarding types and recommended amounts of dynamic (aerobic) training, resistance (anaerobic) training, leisure time physical activity, and non-exercise activity thermogenesis (NEAT). Additional guidance is provided regarding muscle physiology, exercise prescription, metabolic equivalent tasks (METS), and methods to track physical activity progress.

Conclusion

This Obesity Medicine Association Clinical Practice Statement on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity. Implementation of appropriate nutrition and physical activity in patients with pre-obesity and/or obesity may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.

The Role of Physical Activity in Nonalcoholic and Metabolic Dysfunction Associated Fatty Liver Disease

Sedentary behavior constitutes a pandemic health threat contributing to the pathophysiology of obesity and type 2 diabetes (T2D). Sedentarism is further associated with liver disease and particularly with nonalcoholic/metabolic dysfunction associated fatty liver disease (NAFLD/MAFLD). Insulin resistance (IR) represents an early pathophysiologic key element of NAFLD/MAFLD, prediabetes and T2D. Current treatment guidelines recommend regular physical activity. There is evidence, that physical exercise has impact on a variety of molecular pathways, such as AMP-activated protein kinase and insulin signaling as well as glucose transporter 4 translocation, modulating insulin action, cellular substrate flow and in particular ectopic lipid and glycogen storage in a positive manner. Therefore, physical exercise can lead to substantial clinical benefit in persons with diabetes and/or NAFLD/MAFLD. However, experience from long term observational studies shows that the patients’ motivation to exercise regularly appears to be a major limitation. Strategies to integrate everyday physical activity (i.e., nonexercise activity thermogenesis) in lifestyle treatment schedules might be a promising approach. This review aggregates evidence on the impact of regular physical activity on selected molecular mechanisms as well as clinical outcomes of patients suffering from IR and NAFLD/MAFLD.

Dynamic changes in energy expenditure in response to underfeeding: a review

The observation that 64% of English adults are overweight or obese despite a rising prevalence in weight-loss attempts suggests our understanding of energy balance is fundamentally flawed. Weight-loss is induced through a negative energy balance; however, we typically view weight change as a static function, in that energy intake and energy expenditure are independent variables, resulting in a fixed rate of weight-loss assuming a constant energy deficit. Such static modelling provides the basis for the clinical assumption that a 14644 kJ (3500 kcal) deficit translates to a 1 lb weight-loss. However, this '3500 kcal (14644 kJ) rule' is consistently shown to significantly overestimate weight-loss. Static modelling disregards obligatory changes in energy expenditure associated with the loss of metabolically active tissue, i.e. skeletal muscle. Additionally, it disregards the presence of adaptive thermogenesis, the underfeeding-associated fall in resting energy expenditure beyond that caused by loss of fat-free mass. This metabolic manipulation of energy expenditure is observed from the onset of energy restriction to maintain weight at a genetically pre-determined set point. As a result, the observed magnitude of weight-loss is disproportionally less, followed by earlier weight plateau, despite strict compliance to a dietary intervention. By simulating dynamic changes in energy expenditure associated with underfeeding, mathematical modelling may provide a more accurate method of weight-loss prediction. However, accuracy at an individual level is limited due to difficulty estimating energy requirements, physical activity and dietary intake in free-living individuals. In the present paper, we aim to outline the contribution of dynamic changes in energy expenditure to weight-loss resistance and weight plateau.

Obesity: Overview of Weight Management

INTRODUCTION

Obesity is a chronic illness that requires a multifaceted personalized treatment approach.

METHODS & FINDINGS

Using current guidelines and recent studies in weight management, this article reviews the multiple components of weight management: lifestyle intervention (dietary intervention, physical activity, and behavioral interventions), pharmacotherapy, endoscopic procedures, and surgical procedures. This review briefly discusses specific diets and dietary strategies, compensatory mechanisms acting against weight loss, recent changes to Food and Drug Administration approved antiobesity medications, and technological advances in weight management delivery.

CONCLUSION

Current literature is lacking large studies on the safety and efficacy of combination therapies involving pharmacotherapy plus 1 or more procedures.

Metabolic Adaptations to Weight Loss: A Brief Review

ABSTRACT

Martínez-Gómez, MG and Roberts, BM. Metabolic adaptations to weight loss: A brief review. J Strength Cond Res XX(X): 000-000, 2021-As the scientific literature has continuously shown, body mass loss attempts do not always follow a linear fashion nor always go as expected even when the intervention is calculated with precise tools. One of the main reasons why this tends to happen relies on our body's biological drive to regain the body mass we lose to survive. This phenomenon has been referred to as "metabolic adaptation" many times in the literature and plays a very relevant role in the management of obesity and human weight loss. This review will provide insights into some of the theoretical models for the etiology of metabolic adaptation as well as a quick look into the physiological and endocrine mechanisms that underlie it. Nutritional strategies and dietetic tools are thus necessary to confront these so-called adaptations to body mass loss. Among some of these strategies, we can highlight increasing protein needs, opting for high-fiber foods or programming-controlled diet refeeds, and diet breaks over a large body mass loss phase. Outside the nutritional aspects, it might be wise to increase the physical activity and thus the energy flux of an individual when possible to maintain diet-induced body mass loss in the long term. This review will examine these protocols and their viability in the context of adherence and sustainability for the individual toward successful body mass loss.

Sedentarism and chronic disease risk in COVID 19 lockdown - a scoping review

BACKGROUND & AIMS

Though viewed as a critical measure to prevent the spread of the virus, a prolonged homestay may result in unfavourable sedentary behaviour and chronic disease risk. This systematic review focuses on sedentary behaviour resulting from this quarantine period which may elevate the cardiovascular disease risk, obesity, hypertension, cancer and mental health illness.

METHODS

Evidence of breaking sedentary behaviour and global recommendations were investigated. Potential unanswered questions regarding sedentary behaviour and physical activity during lockdown were explored.

RESULTS

Five systematic reviews and six prospective trials explored the effect of sedentarism affecting chronic disease through potential pathophysiological mechanisms. Sedentary behaviour especially prolonged sitting is found to be a pleiotropic risk factor with altered energy expenditure, adipogenic signalling, immunomodulation, autonomic stability and hormonal dysregulation perpetuating underlying chronic diseases such as obesity, cardiovascular disease, cancer and mental health disorders.

CONCLUSION

Breaking sitting and physical activity are found to reverse the adverse effects associated with excessive sitting during the lockdown.

Less sedentary time is associated with a more favourable glucose-insulin axis in obese pregnant women-a secondary analysis of the DALI study

Background/objectives

Obese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women.

Subjects/methods

In this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m², without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness.

Results

232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011).

Conclusions

As the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy.

The effect of exercise interventions on resting metabolic rate: A systematic review and meta-analysis

The systematic review and meta-analysis evaluated the effect of aerobic, resistance and combined exercise on RMR (kCal·day^-1) and performed a methodological assessment of indirect calorimetry protocols within the included studies. Subgroup analyses included energy/diet restriction and body composition changes. Randomized control trials (RCTs), quasi - RCTs and cohort trials featuring a physical activity intervention of any form and duration excluding single exercise bouts were included. Participant exclusions included medical conditions impacting upon RMR, the elderly (≥65 years of age) or pregnant, lactating or post-menopausal women. The review was registered in the International Prospective Register of Systematic Reviews (CRD 42,017,058,503). 1669 articles were identified; 22 were included in the qualitative analysis and 18 were meta-analysed. Exercise interventions (aerobic and resistance exercise combined) did not increase resting metabolic rate (mean difference (MD): 74.6 kCal·day^-1[95% CI: -13.01, 161.33], P = 0.10). While there was no effect of aerobic exercise on RMR (MD: 81.65 kCal·day^-1[95% CI: -57.81, 221.10], P = 0.25), resistance exercise increased RMR compared to controls (MD: 96.17 kCal·day^-1[95% CI: 45.17, 147.16], P = 0.0002). This systematic review effectively synthesises the effect of exercise interventions on RMR in comparison to controls; despite heterogenous methodologies and high risk of bias within included studies.

Making DEEP Sense of Lifestyle Risk and Resilience

To effectively promote life-long health and resilience against – for example – neurodegenerative diseases, evidence-based recommendations must acknowledge the complex multidimensionality not only of the diseases but also of personal lifestyle. In a straightforward descriptive and heuristic framework, more than 50 potential lifestyle factors cluster around diet (D), education (E), exercise (E), and purpose (P), unveiling their many relationships across domains and scales. The resulting systematics and its visualization might be a small but helpful step toward the development of more comprehensive, interdisciplinary models of lifestyle-dependent risk and resilience and a means to explain the opportunities and limitations of preventive measures to the public and other stakeholders. Most importantly, this perspective onto the subject implies that not all lifestyle factors are created equal but that there is a hierarchy of values and needs that influences the success of lifestyle-based interventions.