Effect of melatonin intake on postural balance, functional mobility and fall risk in persons with multiple sclerosis: a pilot study

AIM

To assess the safety and the effect of a nocturnal melatonin (MEL) ingestion on postural balance, functional mobility and fall risk the following morning in adults with multiple sclerosis (MS).

METHODS

Fourteen adults with relapsing-remitting MS (RR-MS) (28.36 ± 6.81 years) were evaluated before and after nocturnal ingestion of MEL (6 mg) or placebo (PLA). Evaluations included a posturographic test of static bipedal postural balance with dual-task in eyes open (EO) and eyes closed conditions, and a clinical test of unipedal balance. The physical performance tests were: Timed Up and Go test (TUGT) (mobility), Four Square Step Test (FSST) (fall risk), and Timed 25-foot walk test (T25FWT) (walking speed). Cognitive performance [Montreal Cognitive Assessment (MoCA) and Simple Reaction Time (SRT) tests] and sleep quality [Spiegel's sleep questionnaire (SSQ)] were also assessed.

RESULTS

In EO condition, MEL decreased the posturographic parameters [center of pressure (CoP) sway area (CoPAr), CoP path length (CoPL) and CoPL in the mediolateral axis (CoPLX)] more than PLA by 15.82% (p = 0.0006), 12.48% (p  = 0.0004) and 14.25% (p = 0.0002), respectively. Durations of TUGT and FSST decreased following MEL session more than the PLA one by 14.52% (p = 0.017) and 19.85% (p = 0.0006), respectively. MEL increased the unipedal stance time, SSQ and MoCA scores more than PLA by 49.81% (p = 0.04), 32.21% (p = 0.004) and 11.87% (p = 0.008), respectively.

CONCLUSION

This pilot study showed that acute nocturnal MEL ingestion seems to be safe for enhancing postural balance, fun mobility and fall risk in RR-MS adults probably through improving sleep quality and cognitive function.

Effects of a nighttime melatonin ingestion on dynamic postural balance and muscle strength the following morning in people living with multiple sclerosis: A preliminary study

BACKGROUND

Decreased endogenous melatonin concentrations in people with multiple sclerosis (PwMS) are associated with fatigue and pain that impair postural balance and muscle strength. Melatonin ingestion had analgesic and anti-fatigue effects. However, the acute effect of exogenous melatonin on dynamic postural stability and muscle strength has not been studied yet in PwMS. This study aimed to investigate the safety and the efficacy of a nighttime melatonin intake on dynamic postural balance and lower-extremity muscle strength the following morning in PwMS.

METHODS

Fourteen PwMS (28.36 ± 6.81 years) were assessed (8 a.m.) pre- and post-acute intake of melatonin or placebo (6mg, 30 minutes before nocturnal bedtime). Evaluated parameters included dynamic postural balance (force platform), lower-extremity muscle strength [Five-Repetition Sit-To-Stand Test (5-STST)], hand dexterity (Nine-Hole Peg Test), nociceptive pain [Visual Analogue Scale (VAS)], neuropathic pain [Neuropathic Pain 4 Questions (DN4)], sleep quality and fatigue perception [Hooper Index (HI)].

RESULTS

In the frontal plane, melatonin reduced the center of pressure (CoP) path length (CoPL), CoPL in the anteroposterior axis (CoPLY) and CoP sway area (CoPAr) compared with placebo by 7.56% (p=0.02, Cohens'd (d)=1.24), 19.27% (p<0.001, d=2.60) and 13.82% (p<0.001, d=2.02), respectively. Melatonin induced a higher decrease in these posturographic parameters compared with placebo in the sagittal plane [CoPL: 9.10% (p=0.005, d=1.02), CoPLY: 4.29% (p=0.025, d=1.07) and CoPAr: 7.45% (p=0.038, d=0.74)]. Melatonin decreased 5-STST duration as well as VAS, DN4, HI-fatigue and HI-sleep scores compared with placebo by 8.19% (p=0.008, d=1.19), 5.74% (p=0.04, d=0.82), 27.30% (p=0.023, d=0.98), 40.15% (p=0.044, d=0.85) and 30.16% (p=0.012, d=1.10), respectively.

CONCLUSION

This preliminary study, among PwMS, showed that acute melatonin ingestion was safe and efficient for improving dynamic postural stability and lower-extremity muscle strength probably through its analgesic and anti-fatigue effects.

Is moderate-intensity interval training more tolerable than high-intensity interval training in adults with obesity?

Interval training (IT) has been shown to be a time-effective alternative to traditional training programmes in the management of obesity. Nevertheless, studies comparing the effects of different IT intensities on inflammation, muscle and liver damage, and perceptual responses in people with obesity are relatively scarce. This study aimed to compare the acute effects of two different IT protocols matched by the mean load and duration on biochemical and perceptual responses in sedentary adults with obesity. Twenty-two volunteers (age = 33.40 ± 10.01 years, BMI = 38.29 ± 7.09 kg/m²) were randomized to perform two conditions: moderate-intensity IT (MIIT) 5 × 3 min (70% of peak power output (PPO))/2 min (45%PPO) and high-intensity IT (HIIT) 8 × 1 min (90%PPO)/2 min (45%PPO). Blood samples were drawn before and after exercise for biochemical and haematological measurements. Rating of perceived exertion (RPE) was assessed during and after exercise. Perceptual pain was evaluated before, throughout and after exercise. C-reactive protein, white blood cells and neutrophils increased only after HIIT (p < 0.001, for all). Aspartate aminotransferase, alanine aminotransferase, creatine kinase and lactate dehydrogenase increased in both HIIT and MIIT (p < 0.001, for all), without any difference between sessions. HIIT induced a greater increase of blood lactate compared to MIIT (p < 0.05). Pain and RPE scores were higher during HIIT vs. MIIT (p < 0.001 and p < 0.01, respectively). MIIT induced fewer immune system perturbations and less muscle pain and was perceived as more tolerable compared to HIIT session. Therefore, MIIT could be used as a first step to promote body adaptations before starting a HIIT programme in sedentary people with obesity.

Effectiveness of Ramadan diurnal intermittent fasting and concurrent training in the management of obesity: is the combination worth the weight?

BACKGROUND AND AIMS

We investigated, in men with obesity, the efficacy of the combination of two strategies (Ramadan diurnal intermittent fasting 'RDIF' strategy vs RDIF plus concurrent training program 'RDIF-CT' strategy) known for their positive impact on body composition and then we explored the possible impact on metabolic and inflammatory biomarkers.

METHODS AND RESULTS

Twenty obese men, age: 31.8 ± 7.05 years, BMI: 33.1 ± 4.2 kg m^-2, performing regularly RDIF, were randomized into two groups: RDIF-CT (n = 10) and RDIF without training (RDIF-NCT) (n = 10). The RDIF-CT group participated in High intensity interval training (HIIT) program combined with resistance exercises for 4 weeks. Body composition, blood glucose, lipid profile, liver biomarkers and inflammation were assessed before and after 4-week RDIF. Both groups showed a significant decrease in weight, fat mass (FM), fat percentage (Fat%) and waist circumference (WC) and an improvement in blood glucose, lipid profile and inflammation. Fat free mass decreased significantly in RDIF-NCT (p < 0.05) while remaining unchanged in RDIF-CT. However, RDIF-CT induced greater improvements in body composition (i.e., weight, FM, Fat% and WC (p < 0.05, p < 0.01, p < 0.01 and p < 0.05; respectively)) as well as greater decrease in lipid biomarkers (i.e., TC, TG and LDL (p < 0.01 for all)), inflammation (i.e., CRP (p < 0.05)), and liver damage (i.e., ASAT, ALAT and Gamma-GT (p < 0.01, p < 0.05 and p < 0.001; respectively)) compared to RDIF-NCT group pre-post intervention.

CONCLUSIONS

Our results suggest that a combination of RDIF and CT induces greater changes in body composition, lipid profile, inflammation and liver biomarkers compared to RDIF strategy alone.

CLINICAL TRIAL REGISTER

PACTR202203475387226.

Effects of intradialytic exercise in combination with melatonin supplementation on functional capacity, postural balance, and quality of life in hemodialysis patients

INTRODUCTION

We evaluated the effect of intradialytic concurrent (resistance-endurance) training combined with melatonin (MEL) supplementation on functional capacity, muscle strength, postural balance, and quality of life (QoL) in hemodialysis (HD) patients.

METHODS

Thirty-three HD patients were randomized into three groups: Exercise (EX)-MEL (n = 11); EX-Placebo (PLA) (n = 11) and Control (C)-PLA (n = 11). Participants included in the EX-MEL and EX-PLA groups were submitted to concurrent training for 12 weeks.

RESULTS

EX-MEL and EX-PLA improved functional capacity, muscle strength, QoL, and postural balance parameters in eyes open and eyes closed conditions. Parameters of postural balance in the dual task condition were improved only in EX-MEL. EX-MEL induced better results in some domains of QoL compared with EX-PLA.

CONCLUSION

Intradialytic concurrent training induced beneficial effects on physical function, muscle strength, postural balance, and QoL in HD patients. MEL supplementation combined with intradialytic exercise lead to better improvements in postural balance and QoL.

Combined effect of gender differences and fatiguing task on postural balance, functional mobility and fall risk in adults with multiple sclerosis: A preliminary study

AIM

To investigate the gender difference effect on postural balance, functional mobility, and fall risk after performing a fatiguing task in adults with multiple sclerosis (MS).

METHODS

Eleven women (30.91 ± 8.19 years) and seven men (30.29 ± 7.99 years) with relapsing-remitting MS performed a fatiguing task: three sets of the Five-repetition Sit-To-Stand Test (5-STST) were performed before and after the six-minute WalkTest (6MWT). Bipedal postural balance in eyes open and eyes closed conditions were assessed prefatigue (T0) and postfatigue (T3) using a force platform. Unipedal balance, functional mobility (Timed Up and Go Test), fall risk (Four Square Step Test) and fatigue [Visual Analogue Scale of Fatigue (VASF)] were assessed at T0 and T3. Heart rate (HR) and Rating of Perceived Exertion (RPE) were recorded before (only for HR), during and after the fatiguing task.

RESULTS

Compared to women, men showed an impairment of posturographic parameters [mean center of pressure (CoP) velocity (CoPVm) in both conditions (p < 0.05); CoP sway area (CoPAr) in both conditions (p < 0.01)], unipedal balance on the dominant leg (p <0.001), mobility (p<0.001) and an increased fall risk (p < 0.05). No gender differences were observed in 6MWT, 5-STST, HR, RPE, and VASF.

CONCLUSION

This preliminary study showed that fatiguing task negatively affected postural control, mobility and fall risk only in men. These gender differences were inconclusive but could be taken into account in postural balance rehabilitation programs for MS persons.

Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity

OBJECTIVES

Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI).

METHODS

A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. The severity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form (UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer.

RESULTS

Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P<0,05). SUI severity was negatively correlated with PFM strength (r=-0,620, P=0,001), isokinetic trunk flexors strength (r=-0,605, P=0,001), and PFM endurance (r=-0,561, P=0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r=0,488, P=0,013).

CONCLUSION

Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found between these two muscle groups may be explained by their synergic activity. These findings suggest that the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI.

LEVEL OF PROOF

3.

Melatonin reduces muscle damage, inflammation and oxidative stress induced by exhaustive exercise in people with overweight/obesity

BACKGROUND

Intense physical exercise leads to inflammation, oxidative stress and muscle damage, and these responses are of greater magnitude in people with obesity. Melatonin (MLT) is considered an endogenous antioxidant which may have beneficial effects against inflammation, oxidative stress and promote tissue repair after exercise. The aim of this study was to examine the effect of MLT on inflammatory parameters, oxidative stress and muscle damage in people with overweight/obesity after a high-intensity interval exercise (HIIE).

METHODS

A total of 23 subjects with obesity (9 men and 14 women) age: 33.26 ± 9.81 years, BMI: 37.75 ± 8.87 kg.m-2 were randomized to participate in two experimental sessions: HIIE + Placebo and HIIE + MLT (3 mg). The HIIE protocol corresponds to 8 intervals of 1 min (90% of the maximal aerobic power (MAP)) alternating with 2 min recovery (45% of the MAP). Blood samples were drawn before and 5 min after each exercise session.

RESULTS

MLT ingestion attenuated the increase of inflammation (C-reactive protein, white blood cells (P < 0.001, ηp2 = 0.45; for both) and Neutrophils (P < 0.01, ηp2 = 0.36)) and hepatic and muscle damage (Aspartate aminotransferase (P < 0.01, ηp2 = 0.25), Alanine aminotransferase (P < 0.01, ηp2 = 0.27) and Creatine kinase (P = 0.02, ηp2 = 0.23). MLT also attenuated the exercise induced lipid and protein peroxidation (i.e., Malondialdehyde (P = 0.03, ηp2 = 0.19) and AOPP (P < 0.001, ηp2 = 0.55)). Concerning the antioxidant status, MLT intake increased Thiol (P < 0.01, ηp2 = 0.26) and Catalase (P < 0.01, ηp2 = 0.32) and decreased Uric acid (P = 0.02, ηp2 = 0.2) and Total bilirubin (P < 0.01, ηp2 = 0.33).

CONCLUSIONS

MLT intake before HIIE reduced muscle damage by modulating oxidative stress and preventing overexpression of the pro-inflammatory mediators in people with obesity.

Importance of Anatomic Peculiarities and Ultrasound-Guided Electromyography of the Extensor Indicis Proprius Muscle

The extensor indicis proprius muscle (EIPM) is considered a key muscle in the assessment of the level of the neurologic lesion causing any motor or sensory medio-cubital impairment of the hand.

The aim of this study is to illustrate the anatomical peculiarities of the EIPM, the ultrasound (US) anatomy of the inferoposterior part of the forearm, and the technique of US-guided electromyography (EMG) of the EIPM.

The US-guided EMG of the EIPM is technically easy and safe for young practitioners, provided there is a good knowledge of US anatomy of the inferoposterior part of the forearm.

Clinical Significance of Anatomic Peculiarities and Ultrasound-Guided Electromyography of the Posterior Tibial Muscle

The posterior tibial muscle (PTM) is a key muscle in diagnosing the level of the neurologic lesion that causes steppage gate that is a paralysis of nervous origin of the muscles ensuring the foot dorsiflexion. The aim of this manuscript is to illustrate the anatomical peculiarities of the PTM, the ultrasound (US) anatomy of the infero-posterior part of the leg, and the technique of US-guided electro-neuro-myography (ENMG) of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate. The US-guided ENMG of the PTM is technically easy and safe for young practitioners provided there is a good knowledge of US anatomy of the infero-posterior part of the leg.

Efficacy of botulinum toxin A for the treatment of hemiparesis in adults with chronic upper limb spasticity

Introduction

this study aimed to evaluate the effectiveness of botulinum toxin A (BoNT-A) injection in hemiparetic patients with chronic spasticity in the upper limb resulting from stroke or traumatic brain injury.

Methods

we conducted a retrospective study including 45 patients seen, in our department of Physical Medicine and Rehabilitation, between January 2014 and December 2016. All patients received an injection of BoNT-A (Dysport, 100 U/ml). Affected upper-extremity muscles could be injected as per the investigator’s discretion to a maximum total dose of 1000 U. We evaluated muscle tone using Modified Ashworth Scale (MAS). Functional disability was assessed using Modified Frenchay Scale (MFS), Nine Hole Peg Test (NHPT) and Barthel Index (BI). Quality of life (QoL) was assessed using the 36-Item Short Form Health Survey (SF-36). The achievement of treatment goal was assessed by the Goal Attainment Scaling (GAS).

Results

patients decreased their MAS score over the first and the third months (p<0.05). MFS showed improvement at 1 month after injection with a median change from baseline of 8 (range: 1-16; p<0.001). The change from baseline ranged from 0 to 5 points for NHPT at 1 month after injection (p< 0.001). This functional improvement was maintained to 3 months. Improvements in Barthel Index was observed at 3 months with a median change from baseline of 5 points (range 0-15; p<0.001). The mean change from baseline of SF-36 score was 4.77 ± 3.39 (p<0.001). The mean GAS T-score was 47.04 ±7.78 (median 50, IQR 7.7), giving a mean (SD) change from baseline of 25.36 ± 8.46 (95% CI 22.82 to 27.90; p <0.001). Binary logistic regression was used to identify the independent factors predicting a favorable functional outcome of Bon-T treatment. It showed that neglect was independent predictive factor treatment failure (p=0.009, OR=3.2) while previous injection of BoNT-A was an independent predictive factors of treatment success (p=0.009, OR=0.3).

Conclusion

our study showed a good response to BoNT-A injection delivered in the management of chronic upper limb spasticity resulting from stroke or traumatic brain injury. It demonstrated its outcome in improving muscle tone, function and QoL. It also showed that the majority of patients achieved their goal as defined at the start of the treatment, mainly for patients who received previous injection of BoNT-A.

Translation and validation of the Intermittent Catheterisation Difficulty Questionnaire (ICDQ) in an Arabic population

Objective: To translate and validate linguistically an Arabic version of the Intermittent Catheterisation Difficulty Questionnaire (ICDQ) adapted to the Tunisian population.

Patients and methods: An Arabic translation and cultural adaptation of the ICDQ was obtained via the reverse translation method after two sets of comprehension tests within two groups of 10 patients. Psychometric validation included testing the questionnaire on a group of 30 patients. Intra-rater reliability was evaluated by the calculation of the intraclass correlation coefficient (ICC) for each item of the questionnaire. Cronbach’s α was used to assess internal consistency.

Results: The study included 30 patients (seven females, 23 males) with a mean (SD) age of 40.6 (15.3) years. The ICC was 0.96, demonstrating excellent intra-rater reliability. Cronbach’s α was 0.96 (>0.9) confirming an excellent correlation between the different items.

Conclusion: This work provides a translated, validated and Tunisian adapted version of the ICDQ that can be used to evaluate Tunisian patients’ difficulties with clean intermittent self-catheterisation in daily practice. We expect that this version will also be helpful for patients in other Arabic and North African countries, although such a hypothesis needs to be confirmed by further studies.

Abbreviations: CISC: clean intermittent self-catheterisation; ICDQ: Intermittent Catheterisation Difficulty Questionnaire; ASIA: American Spinal Injury Association; ICC: intraclass correlation coefficient

Arabic (Tunisian) translation and validation of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7)

Objective: To translate and validate an Arabic (Tunisian) version of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7), which can be used reliably in daily practice and clinical research for Tunisian and Arabic populations. Patients and methods: This cross-sectional study was conducted from January to June 2018. The UDI-6 assesses the presence of urinary incontinence (UI) and the degree of impairment that it causes, whilst the IIQ-7 evaluates women's life quality with lower urinary tract symptoms. As UI is a relatively common condition in middle-aged and older women these tools are utilised worldwide. The Arabic (Tunisian) translation and cultural adaptation of the UDI-6 and IIQ-7 was achieved via the forward/backward method and comprehension test within a group of 15 patients. Psychometric validation included testing the questionnaire on a group of 35 patients. Intra-rater reliability was evaluated by calculation of the intraclass correlation coefficient (ICC) for each item of the questionnaires. Cronbach's α was used to assess internal consistency. The International Consultation on Incontinence Modular Questionnaire short form (ICIQ-SF), in its Arabic version, was used as the 'gold standard'. Results: For the UDI-6, the ICC was 0.98 demonstrating excellent intra-rater reliability and Cronbach's α was 0.99 (>0.9), confirming an excellent correlation between the different items. Internal consistency (Cronbach's α 0.99) and test-retest reliability of the IIQ-7 (ICC 0.98) were very good. For both questionnaires, the κ values for each item ranged from 0.77 to 0.96. Conclusions: We found that the UDI-6 and IIQ-7 questionnaires were valid tools that can be used reliably in daily practice and clinical research for Tunisian and Arabic women with UI. Abbreviations: ICC: intraclass correlation coefficient; ICIQ-SF: Incontinence Modular Questionnaire short form; IIQ-7: Incontinence Impact Questionnaire short form; QoL: quality of life; UDI-6: Urogenital Distress Inventory short form; UI: urinary incontinence.

Neurogenic bowel dysfunction (NBD) translation and linguistic validation to classical Arabic

OBJECTIVE

To translate and linguistically validate in classical Arabic; the French version of the neurogenic bowel dysfunction (NBD).

PATIENTS AND METHODS

Arabic translation of the NBD score was obtained by the "forward translation/backword translation" method. Patients with multiple sclerosis (MS) and spinal cord injury were included. Evaluation of intestinal and anorectal disorders was conducted by the self-administered questionnaire NBD, which was filled twice two weeks apart. An item-by-item analysis was made. The feasibility, acceptability, internal consistency using Cronbach's alpha, and test-retest repeatability by non-parametric Spearman correlation were studied.

RESULTS

Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79±9.16years and the sex-ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The spearman correlation was of 0.842. Internal consistency was judged good through the Cronbach's alpha was of 0.896.

CONCLUSION

The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of its responsiveness to change with a larger number of patients will be the subject of further work.

LEVEL OF EVIDENCE

4.

The effects of backpack load and carrying method on the balance of adolescent idiopathic scoliosis subjects

BACKGROUND CONTEXT

Concerns have been raised about the effect of backpack carrying on adolescent balance. For adolescent idiopathic scoliosis (AIS) subjects, the effect of backpack carrying method on their balance has not been determined. Our aim is to examine the effects of backpack load and carrying method on AIS subjects' balance.

STUDY DESIGN/SETTING

Paired sample matched for age and sex.

PATIENT SAMPLE

Twelve healthy adolescents matched for age and sex with 14 adolescents with mild AIS participated in this study.

OUTCOME MEASURES

A test battery including clinical examination, radiological assessment, and stabilometric measurements of the postural sways in the upright standing posture were conducted.

METHODS

Center of pressure excursions of our subjects were recorded with a stabilometric platform during the upright standing posture without a backpack and while carrying a backpack symmetrically and asymmetrically on each shoulder. For each carrying method, the backpack is loaded at 10% and 15% of body weight (BW).

RESULTS

Our results indicated that postural sways increased with increasing backpack load. These postural sways were observed when normal adolescents carried a backpack loaded with 15% BW load, whereas, for age- and sex-matched AIS subjects, these postural responses were observed for the 10% BW load. The symmetrical backpack carrying induced better balance compared with the asymmetrical one. Asymmetrical carrying on the convex side of the scoliotic curve affects AIS subjects' balance more than carrying it on the concave side.

CONCLUSIONS

Load carriage of 10% BW seems to alter AIS subjects' balance. Asymmetrical carrying should be avoided especially on the convex side of the scoliotic curve because it causes balance impairments that may increase spinal pain.

The effects of an exercise training program on body composition and aerobic capacity parameters in Tunisian obese children

BACKGROUND

The prevalence of children obesity is rising alarmingly in both developed and developing countries. Developing effective exercise programs is a strategy for decreasing this prevalence and limiting obesity-associated long-term comorbidities.

OBJECTIVES

To determine whether a 16-week training program; in addition to the school physical education and without dietary intervention; could have beneficial effects on body composition and aerobic capacity of obese children.

MATERIALS AND METHODS

Twenty-eight obese children (16 boys, 12 girls; aged 12-14 years) were enrolled and were divided into either the exercise group (EG, n = 14) or the control group (CG, n = 14). EG participated in a 16-week aerobic exercises (four 60-min sessions per week at 70-85% of HRmax (maximum heart rate)), in addition to the school physical education. Fat-Free Mass (FFM) and Fat Mass (FM) were assessed with bioelectrical impedance equipment. To assess aerobic capacity, maximal metabolic equivalent of task (METmax) and maximal workload (Wmax) were estimated with an electronically braked cycle ergometer (type Ergoline 500(®)).

RESULTS

At baseline, there were no differences between the two groups. After the training program, only the EG showed significant reduction in BMI (body mass index) and waist circumference compared with the baseline values (P < 0.001). Exercise training significantly decreased FM only in the EG. A significant increase in FFM was seen in both groups; more marked in the EG. There was a significant increase in METmax (P < 0.05) and Wmax (P = 0.02) in the EG, and no significant changes in these parameters were seen in the CG. HRmax significantly decreased only in the EG (P < 0.05).

CONCLUSION

This training program has beneficial effects on body composition and aerobic capacity parameters in obese children. Our intervention has the advantage of providing a sustainable and reproducible school and community approach for the management of children obesity.