Poor Sleep Quality Decreases Concurrent Training Benefits in Markers of Metabolic Syndrome and Quality of Life of Morbidly Obese Patients

The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis

OBJECTIVE

The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life.

METHODS

The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase.

RESULTS

From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments).

CONCLUSION

Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.

Exercise Training Program Improves Subjective Sleep Quality and Physical Fitness in Severely Obese Bad Sleepers

BACKGROUND

Sleep quality is an important modulator of neuroendocrine function, as sleep problems are related to metabolic and endocrine alterations.

OBJECTIVE

The main objective was to determine the effects of an exercise training program on the sleep quality of severely obese patients with sleep problems. The secondary objective was to determine the relationship between fitness and anthropometric parameters with sleep quality scores.

METHODS

Thirty severely obese patients participated in 16 weeks of PA intervention (age: 39.30 ± 11.62 y, BMI: 42.75 ± 5.27 kg/m²). Subjective sleep quality, anthropometric parameters, and fitness (i.e., handgrip strength and cardiorespiratory fitness) were measured.

RESULTS

Two groups were defined as good sleepers (n = 15, 38.06 ± 12.26, men = 1) and bad sleepers (n = 15, 40.53 ± 11.23, men = 3). The good sleeper group reported improvement in cardiorespiratory fitness (61.33 ± 68.75 m vs. 635.33 ± 98.91 m, p = 0.003) and handgrip strength (29.63 ± 9.29 kg vs. 31.86 ± 7.17 kg, p = 0.049). The bad sleeper group improved their cardiorespiratory fitness (472.66 ± 99.7 m vs. 611.33 ± 148.75 m, p = 0.001). In terms of sleep quality dimensions, the bad sleeper group improved their subjective sleep quality (p < 0.001), sleep latency (p = 0.045), sleep duration (p = 0.031), and habitual sleep efficiency (p = 0.015). Comparing the changes in both groups (∆), there were differences in subjective sleep quality scores (∆ = 2.23 vs. ∆ = -3.90, p = 0.002), where 86.6% of the bad sleeper group improved sleep quality (p = 0.030). An increase in handgrip strength was correlated to improving sleep quality scores (r = -0.49, p = 0.050).

CONCLUSIONS

Severely obese bad sleepers improved their subjective sleep quality, the components of sleep, and cardiorespiratory fitness through an exercise training program. Improvement in subjective sleep quality was linked to an increase in handgrip strength.

The Social Distance Impacts from COVID-19 Pandemic on the Development of Two Orders of a Concurrent Training Programme for Morbidly Obese Patients

BACKGROUND

Although there is relevant information regarding the consequences of the coronavirus SARS-CoV-2 (COVID-19), little is known about the impact of the imposed social confinement (at home) on the development of exercise training programmes in populations with morbid obesity.

AIM

To describe the effects of the imposed COVID-19 confinement on the cardiometabolic health benefits acquired through a concurrent training programme that started before the pandemic in populations with morbid obesity.

METHODS

This was an experimental randomized clinical study, in which sedentary morbidly obese women were assigned 1:1 to a high-intensity interval training (HIIT) plus resistance training (RT) group (HIIT + RT; n = 11; BMI 42.1 ± 6.6) or to the same exercise dose, but in different order group of RT plus HIIT group (RT + HIIT; n = 7; BMI 47.5 ± 8.4). Both groups undertook two sessions/week. When COVID-19 confinement at home started, a post-test was applied in January 2020 (Post1) and after 20 months (Post2). The main outcomes were waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), high-density lipids (HDL-c), triglycerides (Tg), and fasting plasma glucose (FPG).

RESULTS

In the HIIT + RT group, the WC showed significant increases from Post1 to Post2 (Δ + 3.1 cm, p = 0.035); in the RT + HIIT group, it decreased from Post1 to Post2 (Δ - 4.8 cm, p = 0.028). In the HIIT + RT group, SBP showed significant increases from Post1 to Post2 (Δ + 6.2 mmHg, p = 0.041); the RT + HIIT group decreased SBP from Pre0 to Post1 (Δ - 7.2 mmHg, p = 0.026) and increased DBP from Pre0 to Post1 (Δ + 8.1 mmHg, p = 0.015). Tg in the HIIT + RT group decreased from Pre0 to Post1 (Δ - 40.1 mg/dL, p = 0.023) but increased from Post1 to Post2 (Δ + 86.3 mg/dL, p < 0.0001).

CONCLUSIONS

The COVID-19 social confinement worsened metabolic syndrome (MetS) outcomes that had improved from 20 weeks' RT + HIIT during the training period, such as WC, SBP, and Tg from HIIT + RT, when, worryingly, SBP increased to another more serious clinical classification in both groups.

Concurrent training and interindividual response in women with a high number of metabolic syndrome risk factors

The non-responders (NRs) after exercise training have been poorly studied in populations with morbid obesity. The purpose of this study was to determine the NR prevalence after 20 weeks of concurrent training of morbidly obese women with a high or low number of metabolic syndrome (MetS) risk factors. Twenty-eight women with morbid obesity participated in an exercise training intervention and were allocated into two groups distributed based on a high (≥3, n = 11) or low number (<3, n = 17) of MetS risk factors. The main outcomes were waist circumference (WC), fasting plasma glucose (FPG), high-density lipids (HDL-c), triglycerides (Tg), and systolic (SBP) and diastolic (DBP) blood pressure, and secondary outcomes were body composition, anthropometric and physical fitness, determined before and after 20 weeks of concurrent training. NRs were defined as previously used technical error cut-off points for the MetS outcomes. Significantly different (all p < 0.05) prevalences of NRs between the H-MetS vs. L-MetS groups (respectively) in WC (NRs 18.2 % vs. 41.1 %, p < 0.0001), SBP (NRs 72.7 % vs. 47.0 %, p = 0.022), DBP (NRs 54.5 % vs. 76.4 %, p < 0.0001), FPG (NRs 100% vs. 64.8 %, p < 0.0001), and HDL-c (NRs 90.9 % vs. 64.7 %, p = 0.012) were observed. In addition, the H-MetS group evidenced significant changes on ΔSBP (−10.2 ± 11.4 mmHg), ΔFPG (−5.8 ± 8.2 mg/dl), ΔHDL-c (+4.0 ± 5.9 mg/dl), and ΔTg (−8.8 ± 33.8 mg/dl), all p < 0.05. The L-MetS group only showed significant changes in ΔWC (−3.8 ± 5.0 cm, p = 0.009). Comparing H-MetS vs. L-MetS groups, significant differences were observed in ∆FPG (−5.8 ± 8.2 vs. +0.3 ± 3.2 mg/dl, p = 0.027), but not in other MetS outcomes. In conclusion, 20 weeks of concurrent training promotes greater beneficial effects in morbidly obese patients with a high number of MetS risk factors. However, the NR prevalence for improving MetS outcomes was significantly superior in these more-diseased groups in SBP, FPG, and HDL-c, independent of their major training-induced effects.

Residual Impact of Concurrent, Resistance, and High-Intensity Interval Training on Fasting Measures of Glucose Metabolism in Women With Insulin Resistance

We sought to assess the residual effects (post 72-h training cessation) on fasting plasma glucose (FPG) and fasting insulin (FI) after 12-weeks of high-intensity interval training (HIIT), resistance training (RT), or concurrent training (CT) in women with insulin resistance (IR). We also aimed to determine the training-induced, post-training residual impact of CT. A total of adult 45 women (age 38.5±9.2years) were included in the final analysis and were assigned to a control (CG; n=13, BMI 28.3±3.6kg/m2), HIIT [n=14, BMI 28.6±3.6kg/m2, three sessions/wk., 80-100% of the maximum heart rate (HRmax)], RT [n=8, BMI 29.4±5.5kg/m2, two sessions/wk., 8-10 points of the modified Borg, corresponding to 20 to 50% range of one maximum repetition test (1RM)], or CT group (n=10, BMI 29.1±3.0kg/m2, three sessions/wk., 80-100% of HRmax, and 8-10 Borg, or 20 to 50% range of 1RM, to each HIIT and RT compounds), with the latter including both HIIT and RT regimens. Training interventions lasted 12-weeks. The main outcomes were FPG and FI measured at pre- and 24-h and 72-h post-training (FPG24h, FI24h, and FPG72h, FI72h, respectively). Secondary endpoints were body composition/anthropometry and the adiposity markers waist circumference (WC) and tricípital skinfold (TSF). The residual effects 72-h post-training [delta (∆)] were significantly poorer (all p<0.01) in the CT group (∆FPG72h+6.6mg/dl, η 2: 0.76) than in the HIIT (∆FPG72h+1.2mg/dl, η 2: 0.07) and RT (∆FPG72h+1.0mg/dl, η 2: 0.05) groups. These findings reveal that HIIT reduces FPG and RT reduces FI 24-h post-training; both exercise interventions alone have remarkably better residual effects on FPG and FI (post-72h) than CT in women with insulin resistance.

Effects of High-Intensity Interval Training on Sleep: A Systematic Review and Meta-Analysis

Objectives: To use a quantitative approach to examine the effects of high-intensity interval training (HIIT) interventions on sleep for adults. Methods: PubMed, Ebsco, Web of Science, Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure, and Wanfang Data were searched from their inception to December 2020. Intervention studies with a control group that examined the effects of HIIT interventions on sleep were included in this meta-analysis. The risk of bias was assessed using the tool provided by the Cochrane Handbook for Systematic Reviews of Interventions. Effect sizes (ESs), calculated as weighted mean difference (WMD) and standardized mean difference (SMD), were used to examine the effects of objective outcomes and subjective outcomes separately. Results: A large increase in sleep quality (SQ) reflected by the Pittsburgh Sleep Quality Index global scores [WMD = −0.90, 95%CI (−1.72, −0.07), p = 0.03, n = 8] and a small-to-medium favorable effect on sleep efficiency (SE) [SMD = 0.43, 95%CI (0.20, 0.65), p = 0.0002, n = 10] were found after HIIT intervention. In addition, sub-analyses results suggest that ESs were moderated by the type, duration and frequency, as well as the length of the HIIT intervention. Conclusions: HIIT may be a promising way to improve overall subjective SQ and objective SE. PROSPERO, protocol registration number: CRD42021241734.