Improved insulin sensitivity and adiponectin level after exercise training in obese Korean youth

Effects of different exercise modalities on inflammatory markers in the obese and overweight populations: unraveling the mystery of exercise and inflammation

In the realm of obesity and overweight, the risk of chronic diseases significantly escalates, closely intertwined with inflammatory factors. Research suggests that specific exercise interventions, particularly aerobic exercise and resistance exercise, can have beneficial effects on inflammation levels. However, debates persist regarding the actual impact of exercise in the obese and overweight population. We employed meta-analysis research methods and searched the China National Knowledge Infrastructure Wanfang Data, PubMed, and Web of Science databases to gather controlled experiments on the effects of resistance exercise or aerobic exercise on C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Two researchers independently conducted literature screening and data extraction. The quality of the literature was assessed according to the Cochrane Handbook standards, and subgroup analyses of CRP, IL-6, and TNF-α were performed using RevMan 5.4 software. Through quantitative synthesis of results from 22 selected studies encompassing a total of 1,135 research subjects, this study systematically explored the specific regulatory effects of different exercise modalities on inflammatory markers in the obese and overweight population. The findings indicate that both aerobic exercise and resistance exercise effectively reduce CRP levels in obese individuals, with aerobic exercise demonstrating a more pronounced effect. Aerobic exercise also significantly lowers IL-6 levels, while the impact of resistance exercise on IL-6 is relatively minor. However, in terms of reducing TNF-α levels, neither modality appears to exert a significant effect. Overall, exercise, especially aerobic exercise, emerges as a positive regulator of inflammatory markers in the context of obesity and overweight.

Adherence and dropout in exercise-based interventions in childhood obesity: A systematic review of randomized trials

Our objective was to systematically examine the characteristics of exercise interventions on adherence and dropout in children and adolescents with obesity. PubMed, Embase, PsycINFO, Lilacs, Scielo, and The Cochrane Central Register of Controlled Trials and reference lists of relevant articles were searched. We included randomized controlled trials with exercise interventions for pediatric patients with obesity presenting data on dropout and/or adherence. Two reviewers screened the records independently for eligibility with disagreements being resolved by a third reviewer. Twenty-seven studies with 1268 participants were included. Because of high heterogeneity and poor reporting of adherence, it was not possible to perform a meta-analysis. Dropout prevalence was calculated, and subgroup analyses comparing different types of exercise and a meta-regression with potential moderators were performed. We found a dropout rate of 13%. Subgroup analyses did not identify significant differences. The duration of the exercise presented a moderating effect on dropout, suggesting that longer exercise sessions may lead to higher dropout in children and adolescents with obesity. Because of the poor adherence data, it is not clear which exercise characteristics may moderate adherence. To improve the quality of childhood obesity care, it is mandatory that future studies present adherence data. Systematic review registration: PROSPERO CRD42021290700.

The effects of exercise training on inflammatory markers in children and adolescents: A systematic review and meta-analysis

INTRODUCTION AND AIM

Exercise training is effective for improving cardiometabolic health in children and adolescents, but less is known about its impact on inflammatory markers. We therefore, undertook a systematic review and meta-analysis to investigate the role of exercise training on pro-inflammatory cytokines including interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) in children and adolescents.

METHOD

A comprehensive search was conducted in three electronic databases including PubMed, Web of Science, and Scopus, from inception to December 2023 to identify exercise trials with and without control groups, involving participants with mean ages ranging from ≥ 6 to < 18 years, of age with measurements of at least one of the following pro-inflammatory cytokines IL-6, TNF-α, or CRP. Standardized mean differences (SMD) and 95 % confidence interval (ICs) were calculated using random effects models.

RESULTS

Thirty-eight studies involving 2043 children and adolescents were included. The results show that exercise training resulted in significant reductions in IL-6 [SMD: -0.44; 95 % CI: -0.68, -0.21; P = 0.001] and CRP [SMD: -0.28; 95 % CI: -0.41, -0.16; P = 0.001], but not TNF-α [SMD: -0.15; 95 % CI: -0.38, -0.07; P = 0.19]. Subgroup analyses showed that IL-6 and CRP were reduced with aerobic training in adolescents, as was CRP with high-intensity interval training.

CONCLUSION

These results provide evidence that exercise training is effective for reducing IL-6 and CRP in adolescents, but not in children, and any benefits may be modulated by the type of exercise performed.

Tumour response following preoperative chemotherapy is affected by body mass index in patients with colorectal liver metastases

BACKGROUND

Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality, with the liver being the primary organ of metastasis. Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases (CRLMs). Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy. However, the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy. Body mass index (BMI) is one of the factors affecting the tumorigenesis and progression of colorectal cancer as well as prognosis after various antitumour therapies. Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight, particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.

AIM

To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.

METHODS

A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023. Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response. The Kaplan-Meier method with log rank test was used to compare progression-free survival (PFS) between patients with high and low BMI. BMI < 24.0 kg/m2 was defined as low BMI, and tumour regression grade 1-2 was defined as complete tumour response.

RESULTS

Low BMI was observed in 74 (58.7%) patients and complete tumour response was found in 27 (21.4%) patients. The rate of complete tumour response was significantly higher in patients with low BMI (29.7% vs 9.6%, P = 0.007). Multivariate analysis revealed that low BMI [odds ratio (OR) = 4.56, 95% confidence interval (CI): 1.42-14.63, P = 0.011], targeted therapy with bevacizumab (OR = 3.02, 95%CI: 1.10-8.33, P = 0.033), preoperative carcinoembryonic antigen level < 10 ng/mL (OR = 3.84, 95%CI: 1.19-12.44, P = 0.025) and severe sinusoidal dilatation (OR = 0.17, 95%CI: 0.03-0.90, P = 0.037) were independent predictive factors for complete tumour response. The low BMI group exhibited a significantly longer median PFS than the high BMI group (10.7 mo vs 4.7 mo, P = 0.011).

CONCLUSION

In CRLM patients receiving preoperative chemotherapy, a low BMI may be associated with better tumour response and longer PFS.

Effect of physical activity on incidence and mortality in patients with gastric cancer: evidence from real-world studies

PURPOSE

Physical activity (PA) has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between PA and the risk of developing gastric cancer (GC). The purpose of this study was to evaluate the impact of PA on the incidence and mortality risk of GC through a meta-analysis, as well as investigate potential dose-response relationships.

METHODS

A systematic literature search was conducted in 10 electronic databases and 4 registries. The combined relative risks (RRs) were calculated using a random-effects model with 95% confidence interval (CIs) to assess the effect of PA on the risk of GC. Relevant subgroup analyses and sensitivity analyses were performed.

RESULTS

The results showed that PA correlated with lower incidence of GC (RR: 0.83, 95% CI: 0.77-0.90), decreased risk of GC mortality (RR: 0.76, 95% CI: 0.66-0.89). The results of the subgroup analysis showed that PA was associated with reduced incidence of GC across gender, different regions, study designs, different sites of GC and different types of PA. A linear relationship was found for frequency of PA.

CONCLUSIONS

This meta-analysis found that PA was associated with a reduced risk of GC incidence and mortality. The correlation between PA and GC occurrence was in a dose-response relationship.

Exercise and Insulin Resistance Markers in Children and Adolescents With Excess Weight: A Systematic Review and Network Meta-Analysis

Importance

Although benefits have been reported for most exercise modalities, the most effective exercise approaches for reducing insulin resistance in children and adolescents with excess weight and the optimal exercise dose remain unknown.

Objective

To compare exercise training modalities and their association with changes in insulin resistance markers among children and adolescents with excess weight and to establish the optimal exercise dose.

Data Sources

For this systematic review and network meta-analysis, 6 electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and CINAHL) were searched for studies from inception to April 1, 2023.

Study Selection

Randomized clinical trials (ie, randomized controlled trials and randomized trials without a control group) were included if they reported outcomes associated with aerobic training, resistance training, high-intensity interval training (HIIT), or a combination of these interventions.

Data Extraction and Synthesis

Data extraction for this systematic review was conducted following a network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Effect sizes were calculated as the mean difference (MD) with 95% CI using random-effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman method. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. The Cochrane Risk-of-Bias tool, version 2 (RoB2), was used to independently assess the risk of bias of the included studies. The certainty of evidence in consistent networks was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. The study protocol was prospectively registered with PROSPERO. Data analyses were conducted between May and June 2023.

Main Outcomes and Measures

The primary outcomes were fasting glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR).

Results

This analysis included 55 studies with a total of 3051 children and adolescents (mean [SD] age, 13.5 [2.3] years; 1537 girls [50.4%] and 1514 boys [49.6%]). Exercise was associated with reductions in fasting insulin (MD, -4.38 μU/mL [95% CI, -5.94 to -2.82 μU/mL]) and HOMA-IR (MD, -0.87 [95% CI, -1.20 to -0.53]). A nonlinear association in both markers was observed, with a required minimal exercise dosage of approximately 900 to 1200 metabolic equivalent of task minutes per week, especially in children and adolescents with insulin resistance at baseline. Combination HIIT and resistance training and concurrent training were the most effective approaches for reducing insulin resistance markers. On average, the certainty of evidence varied from low to moderate.

Conclusions and Relevance

These findings underscore the role of exercise interventions in enhancing insulin resistance markers among children and adolescents with overweight and obesity. It is advisable to include resistance exercises alongside aerobic and HIIT programs for a minimum of two to three 60-minute sessions per week.

Evaluation of the relationship between insulin resistance and 8-iso prostaglandin levels in obesity children

INTRODUCTION

The rising rate of childhood obesity and the serious health problems it causes are gaining increasing attention in medical research and health policy.

Effects of Aerobic Exercise on Serum Adiponectin Concentrations in Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

Serum adiponectin plays a vital role in various physiological processes, such as anti-inflammatory, anti-atherosclerotic, anti-apoptotic and pro-angiogenic activities. Any abnormalities in its concentration can lead to adverse health outcomes, particularly in children and adolescents. Therefore, it is crucial to investigate factors influencing serum adiponectin concentrations in this population. The primary objective of this study was to systematically evaluate the impact of aerobic exercise on serum adiponectin concentrations in children and adolescents with obesity. To achieve this, a comprehensive literature search was conducted up to January 2023, utilising five databases: PubMed, Web of Science, Embase, Cochrane Library and Clinicaltrial.gov. The inclusion criteria involved studies that focused solely on aerobic exercise as an intervention for children and adolescents with obesity. Only studies that reported outcome indicators related to serum adiponectin were considered for analysis. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) assessment tool, and statistical analysis was performed using RevMan 5.4.1 analysis software. This meta-analysis incorporated data from eight trials, involving a total of 272 subjects. The results demonstrated that aerobic training significantly increased serum adiponectin concentrations [standardized mean difference (SMD) = 0.85; 95% confidence interval (CI) = 0.33 to 1.37; I2 = 0%; p = 0.001] in children and adolescents with obesity when compared to non-exercise controls. Furthermore, the magnitude of this effect appears to be influenced by the intensity of aerobic exercise, with higher-intensity aerobic exercise resulting in greater increases in serum adiponectin concentrations.

The Role of Adipokines in Health and Disease

Adipokines are cell-signaling proteins secreted by adipose tissue that has been related to a low-grade state of inflammation and different pathologies. The present review aims to analyze the role of adipokines in health and disease in order to understand the important functions and effects of these cytokines. For this aim, the present review delves into the type of adipocytes and the cytokines produced, as well as their functions; the relations of adipokines in inflammation and different diseases such as cardiovascular, atherosclerosis, mental diseases, metabolic disorders, cancer, and eating behaviors; and finally, the role of microbiota, nutrition, and physical activity in adipokines is discussed. This information would allow for a better understanding of these important cytokines and their effects on body organisms.

Molecular tracking of insulin resistance and inflammation development on visceral adipose tissue

Background

Visceral adipose tissue (VAT) is one of the most important sources of proinflammatory molecules in obese people and it conditions the appearance of insulin resistance and diabetes. Thus, understanding the synergies between adipocytes and VAT-resident immune cells is essential for the treatment of insulin resistance and diabetes.

Methods

We collected information available on databases and specialized literature to construct regulatory networks of VAT resident cells, such as adipocytes, CD4+ T lymphocytes and macrophages. These networks were used to build stochastic models based on Markov chains to visualize phenotypic changes on VAT resident cells under several physiological contexts, including obesity and diabetes mellitus.

Results

Stochastic models showed that in lean people, insulin produces inflammation in adipocytes as a homeostatic mechanism to downregulate glucose intake. However, when the VAT tolerance to inflammation is exceeded, adipocytes lose insulin sensitivity according to severity of the inflammatory condition. Molecularly, insulin resistance is initiated by inflammatory pathways and sustained by intracellular ceramide signaling. Furthermore, our data show that insulin resistance potentiates the effector response of immune cells, which suggests its role in the mechanism of nutrient redirection. Finally, our models show that insulin resistance cannot be inhibited by anti-inflammatory therapies alone.

Conclusion

Insulin resistance controls adipocyte glucose intake under homeostatic conditions. However, metabolic alterations such as obesity, enhances insulin resistance in adipocytes, redirecting nutrients to immune cells, permanently sustaining local inflammation in the VAT.

Relationships of adiponectin to regional adiposity, insulin sensitivity, serum lipids, and inflammatory markers in sedentary and endurance-trained Japanese young women

INTRODUCTION

This study aims to compare the differences in circulating adiponectin levels and their relationships to regional adiposity, insulin resistance, serum lipid, and inflammatory factors in young, healthy Japanese women with different physical activity statuses.

METHODS

Adipokines (adiponectin and leptin), full serum lipid, and inflammatory factors [white blood cell counts, C-reactive protein, tumor necrosis factor-α, tissue plasminogen activator inhibitor-1 (PAI-1)] were measured in 101 sedentary and 100 endurance-trained healthy Japanese women (aged 18-23 years). Insulin sensitivity was obtained through a quantitative insulin-sensitivity check index (QUICKI). Regional adiposity [trunk fat mass (TFM), lower-body fat mass (LFM), and arm fat mass (AFM)] was evaluated using the dual-energy X-ray absorptiometry method.

RESULTS

No significant difference was observed between the sedentary and trained women in terms of adiponectin levels. The LFM-to-TFM ratio and the high-density lipoprotein cholesterol (HDL-C) were the strong positive determinants for adiponectin in both groups. Triglyceride in the sedentary women was closely and negatively associated with adiponectin, as well as PAI-1 in the trained women. The QUICKI level was higher in the trained than sedentary women. However, no significant correlation between adiponectin and insulin sensitivity was detected in both groups. Furthermore, LFM was associated with a favorable lipid profile against cardiovascular diseases (CVDs) in the whole study cohort, but this association became insignificant when adiponectin was taken into account.

CONCLUSIONS

These findings suggest that adiponectin is primarily associated with regional adiposity and HDL-C regardless of insulin sensitivity and physical activity status in young, healthy women. The associations among adiponectin, lipid, and inflammatory factors are likely different in women with different physical activity statuses. The correlation of LFM and a favorable lipid profile against CVD and adiponectin is likely involved in this association.

A Recreational Swimming Intervention during the Whole School Year Improves Fitness and Cardiometabolic Risk in Children and Adolescents with Overweight and Obesity

The benefits of swimming as a treatment for overweight children are undefined. We investigated the effects of recreational swimming on cardiometabolic risk in children/adolescents with normal and excess weight. Participants (n = 49, 26 girls, 10.3 ± 1.8 y) were grouped as 'eutrophic swimming' (EU-Swim, n = 14); 'excess weight swimming' (EW-Swim, n = 20) with an 'obese swimming' subgroup (OB-Swim, n = 10); and 'excess weight sedentary' (EW-Sed, n = 15) with an 'obese sedentary' subgroup (OB-Sed, n = 11). Swimming (50 min, twice/week, moderate-vigorous intensity) was an extra activity during the school year (6 + 3 months with a 3-month school break). Nutritional status, blood pressure (BP), physical activity, cardiorespiratory fitness, biochemical variables, autonomic modulation, endothelial function, abdominal fat, and carotid thickness were assessed at baseline, 6, and 12 months. Greater improvements (p < 0.05) occurred in EW-Swim vs. EW-Sed in body mass index (z-BMI, -16%, d+ 0.52), waist-to-height ratio (W/H, -8%, d+ 0.59-0.79), physical activity (37-53%, d+ 1.8-2.2), cardiorespiratory fitness (30-40%, d+ 0.94-1.41), systolic BP (SBP, -6-8%, d+ 0.88-1.17), diastolic BP (DBP, -9-10%, d+ 0.70-0.85), leptin (-14-18%, d+ 0.29-0.41), forearm blood flow (FBF, 26-41%, d+ 0.53-0.64), subcutaneous fat (SAT, -6%, d+ 0.18), and intra-abdominal fat (VAT, -16%, d+ 0.63). OB-Swim showed improvements vs. OB-Sed in TNFα (-17%, d+ 1.15) and adiponectin (22%, d+ 0.40). Swimming improved fitness and cardiometabolic risk in children/adolescents with overweight/obesity. (TCTR20220216001).

Meta-analysis and systematic review of physical activity on neurodevelopment disorders, depression, and obesity among children and adolescents

Background

No consensus on whether physical activity (PA) is related to physical and mental health among pediatric population remains has been reached to date. To further explore their association, our study assessed the effect of PA on physical and mental health of children and adolescents through a systematic review and meta-analysis of randomized controlled studies (RCTs).

Methods

Several databases(Web of science, PubMed, Embase, Cochrane Central register of controlled trials, CINAHL) were searched from inception to 1st, December 2020 without language restrictions.

Results

38,236 records were identified primitively and 31 included studies with 1,255 participants eventually met our inclusion criteria, all of which exhibited a relatively low-moderate risk of bias of overall quality. In regard to mental health, the administration of PA, compared with the control group, led to moderate improvements in Autism Spectrum Disorder(ASD)[Standard mean difference (SMD) = -0.50, Confidence interval(CI): -0.87, -0.14)] and depression(SMD = -0.68, CI: -0.98, -0.38) among children and adolescents. Similarly, significant result was observed in obesity (SMD = -0.58, CI: -0.80, -0.36). No significant differences were observed in Attention deficit hyperactivity disorder (ADHD) (SMD = -0.29, CI: -0.59, 0.01).

Conclusion

Altogether, PA may have a beneficial effect on children and adolescents with ASD, depression and obesity; nevertheless, there is insufficient evidence to confirm its efficacy in ADHD. More large-scale population based randomized controlled trials are needed to explore more reliable evidence between them.

Improving Body Mass Index of School-Aged Children Using a Nine-Week Rope Skipping Training Intervention: A One-Group Pre-Test Post-Test Design

Studies examining the effectiveness of rope skipping training to improve the body mass index (BMI) of school children are scarce. Hence, this study examined the effectiveness of nine-week skipping training on the BMI of primary six school-aged children (n = 77). The participants underwent 30 min of skipping training three days per week over a nine-week period. The participants’ BMI was measured at the baseline and during weeks 3, 6 and 9. The results from a one-way ANOVA with repeated measures indicated a statistically significant difference in the BMI for both males [F(3,111) = 9.42, p < 0.001, ηp2 = 0.203] and females [F(3,114) = 7.35, p < 0.001, ηp2 = 0.162], suggesting an improvement in BMI. Post hoc comparisons with a Bonferroni adjustment revealed significant differences in BMI after nine weeks of intervention for males between the pre-test (M = 21.47, SD = 4.94) and the 9-week post-test (M = 20.15, SD = 4.36), and for females between the pre-test (M = 21.56, SD = 5.80) and the 9-week post-test (M = 20.68, SD = 5.32). This study demonstrated that regular participation in vigorous physical activity such as skipping training could promote child health by preventing the likelihood of young children being overweight. This result has implications for the inclusion of skipping training into the school life of school-aged children to help manage their BMI levels.

A Meta-Analysis of the Effects of Different Training Modalities on the Inflammatory Response in Adolescents with Obesity

The aim of this study was to investigate the effect of different training modalities on improving the inflammatory response in adolescents with obesity. For the study methodology, the databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, Pubmed, Web of Science, and EBSCO were selected for searching. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) tool, and statistical analysis was performed by applying RevMan 5.4.1 analysis software. A total of 14 studies with 682 subjects were included. The results of this meta-analysis showed that aerobic training (AT) and aerobic plus resistance training (AT + RT) reduced the levels of IL-6 and CRP in adolescents with obesity. Among them, AT + RT was more effective than other training modalities in reducing IL-6 and CRP in adolescents with obesity. Different training modalities have no effect on the TNF-α level in adolescents with obesity. However, regarding the increase in IL-6, CRP, and TNF-α in adolescents with obesity, resistance training (RT) did not lead to significant differences. In conclusion, long-term regular AT, AT + RT, and HIIT are all helpful in improving the inflammatory state of adolescents with obesity, with AT + RT being the best training modality to combat inflammation in adolescents with obesity.

Effects and dose-response relationships of exercise intervention on weight loss in overweight and obese children: a meta-regression and system review

The aim of this study was to determine the effect of different exercise doses on weight loss in obese/overweight children. PubMed, Embase, SPORTDiscus, and the Cochrane library were searched from inception to November 2020 for randomized controlled trials. Fourty six trials involving 2,599 obese/overweight children were finally included. Different exercise dose interventions had different impacts. Exercise intervention reduce body weight (BW) by 1.46 kg (95% CI, -2.35 to -0.56, p=0.001), body fat percentage (BF%) by 2.24 (95% CI, -2.63 to -1.84, p<0.001) and body mass index (BMI) by 1.09 kg/m² (95% CI, -1.45 to -0.73, p<0.001). Each MET-h/week was association with 0.147 kg (95% CI, -0.287 to -0.007, p=0.039) decrease in BW, 0.060 (95% CI, -0.118 to -0.002, p=0.042) decrease in BF%, and 0.069 kg/m² (95% CI, -0.125 to -0.014, p=0.015) decrease in BMI. The findings suggest that there is a positive liner between exercise dose and weight loss, each MET-h/week associated with 0.147 kg, 0.060 and 0.069 kg/m² decrease in body weight, BF%, BMI, respectively.

Comparing the Metabolic Profiles Associated with Fitness Status between Insulin-Sensitive and Insulin-Resistant Non-Obese Individuals

(1) Background: Young non-obese insulin-resistant (IR) individuals could be at risk of developing metabolic diseases including type 2 diabetes mellitus. The protective effect of physical activity in this apparently healthy group is expected but not well characterized. In this study, clinically relevant metabolic profiles were determined and compared among active and sedentary insulin-sensitive (IS) and IR young non-obese individuals. (2) Methods: Data obtained from Qatar Biobank for 2110 young (20-30 years old) non-obese (BMI ≤ 30) healthy participants were divided into four groups, insulin-sensitive active (ISA, 30.7%), insulin-sensitive sedentary (ISS, 21.4%), insulin-resistant active (IRA, 20%), and insulin-resistant sedentary (IRS, 23.3%), using the homeostatic model assessment of insulin resistance (HOMA-IR) and physical activity questionnaires. The effect of physical activity on 66 clinically relevant biochemical tests was compared among the four groups using linear models. (3) Results: Overall, non-obese IR participants had significantly (p ≤ 0.001) worse vital signs, blood sugar profiles, inflammatory markers, liver function, lipid profiles, and vitamin D levels than their IS counterparts. Physical activity was positively associated with left handgrip (p ≤ 0.01) and levels of creatine kinase (p ≤ 0.001) and creatine kinase-2 (p ≤ 0.001) in both IS and IR subjects. Furthermore, physical activity was positively associated with levels of creatinine (p ≤ 0.01) and total vitamin D (p = 0.006) in the IR group and AST (p = 0.001), folate (p = 0.001), and hematocrit (p = 0.007) in the IS group. Conversely, physical inactivity was negatively associated with the white blood cell count (p = 0.001) and an absolute number of lymphocytes (p = 0.003) in the IR subjects and with triglycerides (p = 0.005) and GGT-2 (p ≤ 0.001) in the IS counterparts. (4) Conclusions: An independent effect of moderate physical activity was observed in non-obese apparently healthy individuals a with different HOMA-IR index. The effect was marked by an improved health profile including higher vitamin D and lower inflammatory markers in IRA compared to IRS, and a higher oxygen carrying capacity and lipid profile in ISA compared to the ISS counterparts.

Jump rope training effects on health- and sport-related physical fitness in young participants: A systematic review with meta-analysis

The aim of this systematic review with meta-analysis was to assess the available body of published peer-reviewed articles related on the effects of jump rope training (JRT) compared with active/passive controls on health- and sport-related physical fitness outcomes. Searches were conducted in three databases, including studies that satisfied the following criteria: i) healthy participants; ii) a JRT programprogramme; iii) active or traditional control group; iv) at least one measure related to health- and sport-related physical fitness; v) multi-arm trials. The random-effects model was used for the meta-analyses. Twenty-one moderate-high quality (i.e., PEDro scale) studies were meta-analysed, involving 1,021 participants (male, 50.4%). Eighteen studies included participants with a mean age <18 years old. The duration of the JRT interventions ranged from 6 to 40 weeks. Meta-analyses revealed improvements (i.e., p = 0.048 to <0.001; ES = 0.23-1.19; I² = 0.0-76.9%) in resting heart rate, body mass index, fat mass, cardiorespiratory endurance, lower- and upper-body maximal strength, jumping, range of motion, and sprinting. No significant JRT effects were noted for systolic-diastolic blood pressure, waist-hip circumference, bone or lean mass, or muscle endurance. In conclusion, JRT, when compared to active and passive controls, provides a range of small-moderate benefits that span health- and sport-related physical fitness outcomes.

Exercise and colorectal cancer: prevention and molecular mechanisms

Exercise and physical activity have been shown to be strongly associated with a decreased incidence rate of various chronic diseases especially numerous human malignancies. A huge number of clinical trials and meta-analysis have demonstrated that exercise is significantly effective in lowering the risk of colorectal cancer. In addition, it is suggested as an effective therapeutic modality against this cancer type. Therefore, in this review, we will review comprehensibly the effects of exercise in preventing, treating, and alleviating the adverse effects of conventional therapeutic options in colorectal cancer. Moreover, the possible mechanisms underlying the positive effects of exercise and physical activity in colorectal cancer, including regulation of inflammation, apoptosis, growth factor axis, immunity, epigenetic, etc. will be also discussed.

Exercise is an effective post-treatment management program in colorectal cancer survivals

Exercise improves muscle strength, cardiorespiratory fitness, emotional distress, physical activity, fatigue, and sleep quality in colorectal patients undergoing chemotherapy

Targeting and modulating insulin-like growth factor (IGF) system, inflammation, apoptosis, immunity, epigenetic, Leptin and Ghrelin, and signaling pathways are major underlying mechanisms for preventive effects of exercise in colorectal cancer

Exercise and Cardiovascular Disease Risk Factors in Children and Adolescents With Obesity: A Systematic Review With Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to examine the effects of exercise on cardiovascular disease (CVD) risk factors in children and adolescents with obesity. Randomized controlled trials (RCTs) of exercise ≥4 weeks in children and adolescents with obesity were included if one or more CVD risk factors were included as an outcome. Studies were retrieved by searching 7 electronic databases, cross-referencing, and expert review. Data were pooled using the inverse-variance heterogeneity (IVhet) model and strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Thirty-nine studies representing 1548 participants (847 exercise, 701 control) met the inclusion criteria. Aerobic exercise improved 10 of 12 (83.3%) outcomes (P < .05 for all) while combined aerobic and strength training improved 5 of 8 (62.5%) outcomes (P < .05 for all). The strength of evidence ranged from "very low" to "moderate." It was concluded that aerobic exercise, as well as combined aerobic and strength training, is associated with improvements in multiple CVD risk factors among children and adolescents with obesity. However, the generally low strength of evidence suggests a need for future well-designed and conducted RCTs on the effects of exercise, especially strength training, in children and adolescents with obesity.

Effect of Exercise Training on Body Composition and Inflammatory Cytokine Levels in Overweight and Obese Individuals: A Systematic Review and Network Meta-Analysis

Objective

This study aimed to compare and rank the effectiveness of aerobic exercise (AE), resistance training (RT), combined aerobic and resistance training (CT), and high-intensity interval training (HIIT) on body composition and inflammatory cytokine levels in overweight and obese individuals by using network meta-analysis (NMA).

Methods

We searched the PubMed, Cochrane, Embase, Web of Science, and EBSCO databases to identify randomized controlled trials investigating the effects of exercise training on inflammatory cytokines in overweight and obese patients. The retrieval period was from inception to November 2021. Two reviewers independently screened the retrieved articles, extracted the pertinent data, and assessed the risk of bias of the included studies; then, they used Stata 16.0 and Review Manager 5.3 to perform an NMA.

Results

A total of 38 studies involving 1317 patients were included in this study. The results of the NMA indicated that AE had the greatest effect on weight loss (SUCRA=78.3; SMD=−0.51, 95% CI: −0.70, −0.33); CT had the greatest effect on reducing body mass index (SUCRA=70.7; SMD=−0.46, 95% CI: −0.81, −0.10), waist circumference (SUCRA=93.4; SMD=−1.86, 95% CI: −2.80, −0.93), percentage body fat (SUCRA=79.6; SMD=−1.38, 95% CI: −2.29, −0.48), interleukin-6 level (SUCRA=86.4; SMD=−1.98, 95% CI: −3.87, −0.09), and tumor necrosis factor-α level (SUCRA=79.4; SMD=−2.08, 95% CI: −3.75, −0.42); AE (SMD=0.51, 95% CI: −1.68, 2.69), RT (SMD=0.15, 95% CI: −3.01, 3.32), CT (SMD=1.78, 95% CI: −1.35, 4.92), and HIIT (SMD=2.29, 95% CI: −1.27, 5.86) did not significantly increase the adiponectin level.

Conclusion

The current results suggest that CT is the best exercise modality for improving body composition and inflammatory status in overweight and obese individuals. More rigorous randomized control trials are needed for further validation.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022303165.

Clinical (BMI and MRI) and Biochemical (Adiponectin, Leptin, TNF-α, and IL-6) Effects of High-Intensity Aerobic Training with High-Protein Diet in Children with Obesity Following COVID-19 Infection

Objective: To find the clinical and biochemical effects of high-intensity aerobic training with a high-protein diet in children with obesity following COVID-19 infection. Methods: By using the block randomization method, the eligible participants were randomized into two groups. The first group received high-intensity aerobic training with a high-protein diet (Group A; n = 38) and the second group were allowed to do regular physical activities and eat a regular diet (Group B; n = 38) for 8 weeks. Clinical (basal metabolic index (BMI) and muscle-mass-cross-sectional area (CSA)) and biochemical (Adiponectin, leptin, TNF-α, and IL-6) measures were measured at baseline, on the 8th week, and at 6-months follow-up. Results: Baseline demographic and clinical attributes show homogenous presentation among the study groups (p > 0.05). After eight weeks of intervention, and at the end of 6-months follow-up, the basal metabolic index (BMI) (6.3) (CI 95% 4.71 to 7.88), mid-arm CSA (17) (CI 95% 14.70 to 19.29), mid-thigh CSA (13.10) (CI 95% 10.60 to 15.59), mid-calf CSA (11.3) (CI 95% 9.30 to 13.29), adiponectin (−1.9) (CI 95% −2.13 to −1.66), leptin (5.64) (CI 95% 5.50 to 5.77), TNF-α (0.5) (CI 95% 0.42 to 0.57), and IL-6 (0.21) (CI 95% 0.18 to 0.23) showed more improvement (p < 0.001) in Group A than Group B (p > 0.05). Conclusion: Overall, this trial found that high-intensity aerobic training with a high-protein diet decreased the BMI percentile and muscle mass (arm, thigh, and calf), and positively altered the biochemical variables in children with obesity.

Effects of Different Doses of Exercise on Inflammation Markers Among Adolescents With Overweight/Obesity: HEPAFIT Study

PROPOSE

Obesity-related metabolic risk factors in adolescents who are overweight/obese may be associated with systemic low-grade inflammation; therefore, we investigated whether 6 months of exercise training altered markers of inflammation.

METHODS

Secondary analyses of a randomized controlled exercise-based intervention trial (September 2017-December 2018). Adolescents aged 11 to 17 years (Tanner stage II-V), 70% girls, with a body mass index z-score at or above the 85th percentile, and/or with excess of adiposity (body fat ≥ 30%). The participants were randomly assigned to the following 4 groups for 6 months: (1) standard physical education lessons, as a control (CTRL); (2) high-intensity physical education class (HIPE); (3) low-to-moderate intensity physical education class (LIPE); (4) a combined group (PLUS). Inflammatory markers and immune molecules including chemokines, cytokines, and growth factors (n = 65 biomarkers) were determined by cytokine antibody array.

RESULTS

Of the 120 randomly assigned participants, 95 were included in the analysis. Considering these 22 proteins, the LIPE group shows statistical significance in 9 proteins with log-fold change (logFC) and P < 0.05 (in BLC, eotaxin, fibroblast growth factor-6 [FGF-6], GCP-2, I-309, IGFBP-4, MCP-4, NAP-2, and PARC), followed by the PLUS group in 9 proteins (BLC, pro-epidermal growth factor, eotaxin, FGF-6, MCP-4, NAP-2, osteopontin, PARC, and RANTES), the HIPE group in 7 proteins (FGF-4, FGF-7, GCP-2, IGF-1, IGFBP-1, IGFBP-4, and MIP-1 delta), and the CTRL group in 6 proteins (FGF-4, IP-10, Leptin, MCP-1, MIG, and MIP-1 delta). However, subanalysis performed to detect differentially expressed proteins at baseline and after intervention, with significance at an adjusted P value ≤ 0.05 and absolute log fold-change (logFC) ≥ 1.0, showed 3 downregulated proteins in the LIPE group (BLC(logFC) = 1.27, eotaxin(logFC) = 1.18, and MCP-4(logFC) = 1.14), and 4 proteins in the HIPE group (BLC(logFC) = 1.45, FGF-6(logFC) = 1.20, MCP-4(logFC) = 1.50, and PARC(logFC) = 1.33), supporting that the changes we observed in the exercise groups were not time-related changes but occurred in response to exercise.

CONCLUSIONS

Implementing a 6-month physical exercise program in overweight/obese adolescents, based on LIPE and PLUS groups, significantly change several circulating inflammatory levels. Interventions involving supervised physical exercise may reduce the associated effects of systemic low-grade inflammation, thus preventing the development of obesity-related metabolic diseases in adolescents with overweight/obesity.

Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis

BACKGROUND

Various interventions have been tested to prevent or treat childhood obesity in South Korea. However, the overall effect of those interventions is unclear, as very few reviews and meta-analyses were specific to Korean children and adolescents.

PURPOSE

We aimed to examine the overall effect of obesity interventions among Korean children and adolescents, while also examining differences by sex, age group, baseline weight category, intervention duration, number of intervention components, and type of intervention components.

METHODS

A meta-analysis was conducted for all intervention studies sampling Korean children and adolescents, with at least one control group and one month of follow-up, published between January 2000 and August 2020. Cohen d was calculated as an effect size for treatment effect, using the standardized difference between intervention group's body mass index (BMI) change and control group's BMI change.

RESULTS

The final sample included 19 intervention studies with 2,140 Korean children (mean age, 12.2 years). Overall, interventions were strongly favored over their controls (d=1.61; 95% confidence interval [CI], 1.12-2.09). The subgroup analysis showed that interventions with at least one physical activity component (d=2.43; 95% CI, 1.63-3.24) were significantly better than those that did not include physical activity (d=0.02; 95% CI, -0.26 to 0.31).

CONCLUSION

Type of intervention component appeared important, though no differential association was observed by sex, age, baseline weight category, intervention duration, and number of intervention components. Korean and non-Korean interventions may be substantively different. Additional studies are needed to understand why and how Korean interventions differ from non-Korean interventions.

Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Lean / Fat Free Body Mass (LBM) is metabolically involved in active processes such as resting energy expenditure, glucose uptake, and myokine secretion. Nonetheless, its association with insulin sensitivity / resistance / glucose tolerance and metabolic syndrome remains unclear in childhood.

METHODS

The current investigation aimed to examine the differences in fat-free mass /lean body mass according to the presence of insulin sensitivity/insulin resistance/glucose tolerance/metabolic syndrome in children. A systematic search was carried out in Medline/PubMed, Embase, Scopus, Web of Science, and SciELO, covering the period from each database's respective start to 21 June 2021. Two researchers evaluated 7111 studies according to the inclusion criteria: original human studies, written in English or Spanish, evaluating fat-free mass/lean body mass in children and adolescents including both with and without insulin sensitivity/insulin resistance /glucose tolerance and metabolic syndrome and reported the differences between them in terms of fat free mass/lean body mass. The results of the studies were combined with insulin sensitivity, insulin, resistance, glucose tolerance and metabolic syndrome. The standardized mean difference (SMD) in each study was calculated and combined using the random-effects model. Heterogeneity between studies was tested using the index of heterogeneity (I2), leave-one-out sensitivity analyses were performed, and publication bias was assessed using the Egger and Begg tests.

RESULTS

Finally, 15 studies which compared groups defined according to different glucose homeostasis criteria or metabolic syndrome out of 103 eligible studies were included in this systematic review and 12 studies in the meta-analysis. Meta-analysis showed lower fat-free mass/lean body mass percentage in participants with insulin resistance/glucose tolerance/metabolic syndrome (SMD -0.47; 95% CI, - 0.62 to - 0.32) while in mass units (kg), higher values were found in the same group (SMD, 1.01; 95% CI, 0.43 to 1.60).

CONCLUSIONS

Our results identified lower values of fat-free mass/lean body mass (%) in children and adolescents with insulin resistance/glucose tolerance/metabolic syndrome and higher values of fat-free mass/lean body mass when these are expressed in kg. The evidence of the impact of lean mass on children's glucose homeostasis or metabolic syndrome is limited, so future studies research should focus on explaining the effect of fat-free mass/lean body mass on different metabolic outcomes. Moreover, it may be interesting to evaluate the quality (muscle density) or functional (muscle strength) outcomes in addition to both absolute (kg) and relative (%) values in future studies. The systematic review was prospectively registered at PROSPERO (registration number CRD42019124734; available at: http://www.crd.york.ac.uk/prospero [accessed: 05 April 2019]).

The Effect of All Extremity High Intensity Interval Training on Athero-Protective Factors and Endothelial Function in Overweight and Obese Women

Context:

Obesity is associated with endothelial dysfunction and cardiovascular diseases. Adiponectin and fibroblast growth factor 21 (FGF21) as hormones are highly contributive in cardiovascular system, while they are disrupted through obesity. Weight-bearing high intensity interval training (HIIT) as an effective procedure in preventing obesity-related complications in adults with obesity may be limited due to the subjects' muscular weakness and complications interfering walking.

Aims:

The purpose of this study was to assess the effectiveness of non-weight bearing all extremity HIIT (all ex. HIIT) on FGF21, adiponectin, nitric oxide (NO), and flow mediated dilation (FMD) in overweight and obese women.

Methods:

Thirty healthy overweight and obese sedentary university female students within 20.53 ± 1.50 age range and BMI ≥27 kg.m^-2 were assigned in two experimental and control groups. All ex. HIIT consisted of 4 × 4 min at 85–90% max HR with an interspersed with 3 × 3 min recovery per round at 70% max HR by upper and lower ergometers in a simultaneous manner on 10 weeks of four sessions of 40 min each. FGF21, adiponectin, NO, FMD, weight, waist and maximal oxygen uptake (VO_2max) were measured in pre and post-tests. Paired sample t-test and analysis of covariance are applied for statistical analysis.

Results:

Results indicated a significant increase in adiponectin (P ≤ 0.01) and FMD (P ≤ 0.001), while there existed no changes in FGF21 at (P ≥ 0.10) and NO (P ≥ 0.84). The weight and waist decreased at (P ≤ 0.001), and the VO_2max increased at (P ≤ 0.001).

Conclusions:

All ex. HIIT may be a safe alternative for overweigh and obese women who have complications with weight-bearing exercises, and may increase adiponectin, and improve the FMD, aerobic fitness, and body composition.

The Combined Effects of 6 Weeks of Jump Rope Interval Exercise and Dark Chocolate Consumption on Antioxidant Markers in Obese Adolescent Boys

Research has shown that both dark chocolate and exercise training may have favorable effects on antioxidant function in obese cohorts. However, their combined effect has not been established. We assessed the influences of six weeks of dark chocolate consumption combined with jump rope exercise on antioxidant markers in adolescent boys with obesity. Fifty adolescent boys with obesity (age = 15 ± 1 years) were randomly assigned into one of four groups; jump rope exercise + white chocolate consumption (JW; n = 13), jump rope exercise + dark chocolate consumption (JD; n = 13), dark chocolate consumption (DC; n = 12), or control (C; n = 12). Two participants dropped out of the study. Participants in JW and JD groups performed jump rope exercise three times per week for six weeks. Participants in the DC and JD groups consumed 30 g of dark chocolate containing 83% of cocoa during the same period. Serum concentrations of superoxide dismutase (SOD), total antioxidant capacity (TAC), glutathione peroxidase (GPx), and thiobarbituric acid reactive substances (TBARS) were evaluated prior to and after the interventions. All 3 intervention groups noted significant (p < 0.01) increases in serum concentrations of TAC, SOD, and GPx from baseline to post-test. In contrast, all intervention groups showed significantly reduced serum concentrations of TBARS from pre- to post-test (p ≤ 0.01). Bonferroni post hoc analysis revealed that post-test serum concentrations of TAC in the JD group were significantly greater than C (p < 0.001), DC (p = 0.010), and JW (p < 0.001) groups. In addition, post-test serum concentrations of SOD in the JD group were significantly greater than C group (p = 0.001). Post-test serum concentrations of GPx in the JD group were significantly greater than C (p < 0.001), DC (p = 0.021), and JW (p = 0.032) groups. The post-test serum concentrations of TBARS in the JD group was significantly lower than C (p < 0.001). No other significant between-group differences were observed. The current study provides evidence that dark chocolate consumption in combination with jump rope exercise is more efficient in improving antioxidant capacity than dark chocolate consumption or jump rope exercise alone among obese adolescent boys.

Effects and Responsiveness of a Multicomponent Intervention on Body Composition, Physical Fitness, and Leptin in Overweight/Obese Adolescents

Physical exercise reduces the biochemical markers of obesity, but the effects of multicomponent interventions on these markers should be explored. The present study aimed to elucidate how overweight/obese adolescents respond to a multicomponent program approach on body composition, physical fitness, and inflammatory markers, using a quasi-experimental study with 33 overweight/obesity adolescents (control group (CG) = 16; intervention group (IG) = 17). The intervention consisted of 24 weeks with physical exercises and nutritional and psychological guidance. Both groups were evaluated at the pre/post-intervention moments on body mass index (BMI); body fat (%Fat); waist circumference (WC); waist/hip ratio (WHR); waist-to-height ratio (WHtR), cardiorespiratory fitness (CRF); abdominal strength, flexibility; leptin; interleukin 6; interleukin 10; and tumor necrosis factor-alpha. Mixed-analysis of variance and generalized estimation equations were used for statistical analysis. There was an interaction effect between groups and time on %Fat (p = 0.002), WC (p = 0.023), WHR (p < 0.001), WHtR (p = 0.035), CRF (p = 0.050), and leptin (p = 0.026). Adolescents were classified as 82.4% responders for %Fat, 70.6% for WC, 88.2% for WHR, and 70.6% for CRF. Further, there was an association between changes in %Fat (p = 0.033), WC (p = 0.032), and WHR (p = 0.033) between responders and non-responders with CRF in the IG. There was a positive effect on body composition, physical fitness, and leptin. In addition, reductions in body composition parameters were explained by CRF improvements.

The impacts of exercise on pediatric obesity

Over the last few decades, the rates of pediatric obesity have more than doubled regardless of sociodemographic categorization, and despite these rates plateauing in recent years there continues to be an increase in the severity of obesity in children and adolescents. This review will discuss the pediatric obesity mediated cardiovascular disease (CVD) risk factors such as attenuated levels of satiety and energy metabolism hormones, insulin resistance, vascular endothelial dysfunction, and arterial stiffness. Additionally, early intervention to combat pediatric obesity is critical as obesity has been suggested to track into adulthood, and these obese children and adolescents are at an increased risk of early mortality. Current suggested strategies to combat pediatric obesity are modifying diet, limiting sedentary behavior, and increasing physical activity. The effects of exercise intervention on metabolic hormones such as leptin and adiponectin, insulin sensitivity/resistance, and body fat in obese children and adolescents will be discussed along with the exercise modality, intensity, and duration. Specifically, this review will focus on the differential effects of aerobic exercise, resistance training, and combined exercise on the cardiovascular risks in pediatric obesity. This review outlines the evidence that exercise intervention is a beneficial therapeutic strategy to reduce the risk factors for CVD and the ideal exercise prescription to combat pediatric obesity should contain both muscle strengthening and aerobic components with an emphasis on fat mass reduction and long-term adherence.

Diabetes-Alzheimer's Disease Link: Targeting Mitochondrial Dysfunction and Redox Imbalance

Significance: It is of common sense that the world population is aging and life expectancy is increasing. However, as the population ages, there is also an exponential risk to live into the ages where the brain-related frailties and neurodegenerative diseases develop. Hand in hand with those events, the world is witnessing a major upsurge in diabetes diagnostics. Remarkably, all of this seems to be narrowly related, and clinical and research communities highlight for the upcoming threat that it will represent for the present and future generations. Recent Advances: It is of utmost importance to clarify the influence of diabetes-related metabolic features on brain health and the mechanisms underlying the increased likelihood of developing neurodegenerative diseases, in particular Alzheimer's disease. Thereupon, a wealth of evidence suggests that mitochondria and associated oxidative stress are at the root of the link between diabetes and co-occurring disorders in the brain. Critical Issues: The scientific community has been challenged with constant failures of clinical trials raising major issues in the advance of the therapeutic field to fight chronic diseases epidemics. Thus, a change of paradigms is urgently needed. Future Directions: It has become urgent to identify new and solid candidates able to clinically reproduce the positive outcomes obtained in preclinical studies. On this basis, strategies settled to counteract diabetes-induced neurodegeneration encompassing mitochondrial dysfunction, redox status imbalance, and/or insulin dysregulation seem worth to follow. Hopefully, ongoing innovative research based on reliable experimental tools will soon bring the desired answers allowing pharmaceutical industry to apply such knowledge to human medicine.

The effects of physical activity on adipokines in individuals with overweight/obesity across the lifespan: A narrative review

This narrative review summarizes current knowledge on the effects of physical activity (PA) on adipokine levels in individuals with overweight and obesity. Approximately 90 investigations including randomized control, cross-sectional and longitudinal studies that reported on the effects of a single session of PA (acute) or long-term PA (chronic) on adipokine levels in individuals with overweight/obesity were reviewed. The findings support the notion that there is consensus on the benefits of chronic exercise training-regardless of the mode (resistance vs. aerobic), intensity and cohort (healthy vs. diabetes)-on adipokine levels (such as tumour necrosis factor-alpha, interleukin-6, adiponectin, visfatin, omentin-1 and leptin). However, several confounding factors (frequency, intensity, time and type of exercise) can alter the magnitude of the effects of an acute exercise session. Available evidence suggests that PA, as a part of routine lifestyle behaviour, improves obesity complications by modulating adipokine levels. However, additional research is needed to help identify the most effective interventions to elicit the most beneficial changes in adipokine levels in individuals with overweight/obesity.

Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes?

Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.

Moderate aerobic training modulates cytokines and cortisol profiles in older adults with cognitive abilities

Excessive expression of cortisol and pro-inflammatory cytokines exerts a negative affect on cognitive functioning and hippocampal structure in older adults. Although the interrelation between cortisol and cytokines was fully elucidated previously, few studies considered how their association with exercise can affect brain structures or play an anti-inflammatory role in preserving cognitive function among older adults. To evaluate both the neuro-protective and anti-inflammatory activities of moderate aerobic exercise in improving cognitive performance among healthy older adults, the serum levels of CRP, TNF-α, IL-6, and cortisol and their correlation with cognitive performance were estimated in all participants. A total of 60 healthy older adults aged 50-85 years were included in this study. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) test, colorimetric testing, and ELISA immunoassays were used to measure cognitive abilities; blood sugar; and glycated hemoglobin (HbA1c), cortisol, IL-6, TNF-α, and CRP, respectively, in older adults before and after 12-week exercise interventions. Exactly 50% of the participants showed moderate cognitive impairment (MCI) (LOTCA scores: 84.8 ± 8.2), and the remaining 50% of the participants (n = 30) were diagnosed as normal healthy subjects (LOTCA scores: 98.7 ± 8.1). There was a significant association between cognitive decline in LOTCA scores of motor praxis, vasomotor organization, thinking operations, and attention and concentration and higher levels of cortisol, CRP, TNF-α, and IL-6, as well as adiposity markers BMI and WHR, in the MCI group compared to control subjects. However, significant improvements in the same LOTCA score domains in MCI subjects were recorded along with decrements in the levels of cortisol and cytokine CRP, TNF-α, and IL-6, as well as improved adiposity markers, following a 12-week moderate exercise program. Cognitive performance correlated positively with cortisol levels and negatively with physical activity, adiposity markers, and cytokine levels. Also, in participants with normal and abnormal cortisol profiles, there was a positive interrelation between cytokine levels and cortisol. Moderate aerobic exercise for 12 weeks showed beneficial effects on cognitive performance in older adults. Our results suggest that 12 weeks of aerobic exercise improves cognitive disorders in older adults via modulating stress and pro-inflammatory cytokines. This may have been due to significant changes in the levels of cortisol, IL-6, TNF-α, and CRP, and physical activity may thus be used as non-drug strategy for treating cognitive disorders.

Effects of Interval Jump Rope Exercise Combined with Dark Chocolate Supplementation on Inflammatory Adipokine, Cytokine Concentrations, and Body Composition in Obese Adolescent Boys

We examined the effects of six weeks of dark chocolate supplementation combined with interval jump rope exercise (JRE) on inflammatory cytokines, adipokines, and body composition in obese adolescent boys. Forty-eight obese adolescent boys (age  = 15.4  ±  1.1 years and body mass index  =  32.2  ±  2.4 kg/m²) were randomly assigned into one of four groups: JRE + white chocolate (JW; n = 13), JRE + dark chocolate supplementation (JD; n = 13), dark chocolate supplementation (DS; n = 12), or control (C; n = 12). Participants in JW and JD groups performed JRE for three times per week for six weeks. Participants in the DS and JD groups consumed 30 g of dark chocolate containing 83% of cocoa. Body composition, pro-inflammatory cytokines ((hs-CRP, TNF-α, IL-6), adipokines (leptin, resistin, RBP-4, chemerin, MCP-1), and anti-inflammatory adipokines (irisin, adiponectin)) were evaluated prior to and after the intervention trials. All three intervention trials significantly (p < 0.05) decreased body mass, waist-hip ratio, fat mass, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, and increased irisin and adiponectin concentrations. The improvements in these parameters were greater in the JD group, and additionally, chemerin concentrations decreased only in the JD group. JD enhanced adiponectin concentrations and decreased IL-6 concentrations compared to C. Moreover, JD significantly reduced chemerin concentrations, an effect not observed in any of the other interventions. We demonstrated that dark chocolate supplementation potentiated JRE-induced decreases in body mass, WHR, FM, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, chemerin as well as increases irisin and adiponectin concentrations in obese adolescent boys. Therefore, JRE combined with dark chocolate supplementation could be a beneficial in reducing obesity-induced inflammation in adolescent boys.

Effects of physical training on anthropometrics, physical and physiological capacities in individuals with obesity: A systematic review

Increasing the amount of physical activity is an important strategy for weight loss. This systematic review summarizes recent findings on the effects of physical training on anthropometric characteristics, physical performances and physiological capacities in individuals with overweight and obesity. A systematic literature search strategy was conducted from inception until June 2019 using four electronic databases that identified 2,708 records. After screening for titles, abstracts and full texts, 116 studies were included in our final analysis. Both aerobic (e.g., endurance training) and anaerobic training (e.g., high-intensity training, resistance training) improved body composition and physical fitness indicators in adults, adolescents and children with obesity (effect size: 0.08 < d < 2.67, trivial to very large). This systematic review suggests that both low- and high-intensity training significantly reduced body weight and fat mass while increasing fat-free mass in individuals with obesity (effect size: 0.04 <d <3.2, trivial to very large). A significant increase in VO_2max also occurs in individuals with obesity in response to aerobic training or high-intensity interval training (effect size: 0.13 < d < 6.24, trivial to very large). Further studies are needed to define the optimal combination of training intensity and duration needed to produce the most efficacious results in individuals with obesity.

Impact of high-intensity interval training and sprint interval training on peripheral markers of glycemic control in metabolic syndrome and type 2 diabetes

Glycemic control is essential to reduce the risk of complications associated with metabolic syndrome (MetS) and type 2 diabetes (T2D). Aerobic and resistance exercise performed alone or in combination improve glycemic control in both conditions. However, perceived lack of time and commitment are considered principal barriers to performing exercise regularly. High intensity interval training (HIIT) and sprint interval training (SIT) can be performed in a fraction of the time required for continuous aerobic exercise. A substantial scientific evidence indicates that HIIT/SIT improve glycemic control to a similar or greater extent than aerobic exercise in populations without MetS or T2D. Likewise, growing evidence suggest that HIIT/SIT improve the glycemic control during MetS and T2D. The aim of this review is to discuss the effects of interval training protocols on peripheral markers of glucose metabolism in patients with MetS and T2D.

Effect of Strength Training on Glycemic Control and Adiponectin in Diabetic Children

PURPOSE

This study aimed to examine the effect of isolated supervised progressive resistance training with duration of more than 32 wk on muscle strength, metabolic control and adiponectin.

METHOD

Twenty-one children with type 1 diabetes mellitus were separated into an intervention group (IG) (n = 11 age 11.0 ± 0.8) and a control group (CG) (n = 10 age 11.30 ± 0.7) without training to control for the effect of progressive resistance training on muscle strength, hemoglobin (HbA)1C and adiponectin. All parameters were assessed before and after a period of 32 wk. No attempt was made to change diet and the daily behaviors during the study in both groups.

RESULTS

After a period of 32 wk, upper and lower limb strength increased significantly (P < 0.05) in the IG, whereas no changes occurred in the CG. In the IG, HbA1C decreased significantly after 32 wk but not after 17 wk (P < 0.00), whereas HbA1C increased in the CG (P < 0.007). Adiponectin increased significantly (P < 0.000) only in the IG. Self-monitored blood glucose levels, measured before and after each session, showed a significant reduction (P < 0.00) of 26.5% ± 4.4% after each session. Effect size (ES) for the strength training on limb strength was medium (d = 0.464 to d = 0.661), the ES for strength training on HbA1C (d = -1.292) and the ES for strength training on adiponectin (d = 1.34) was large. There was no hypoglycemia as the result of training.

CONCLUSIONS

An isolated supervised progressive resistance training two times a week in children with type 1 diabetes mellitus must last at least 32 wk to get a significant decrease in blood glucose level HbA1C. In addition, exercise-induced increase in adiponectin improves insulin sensitivity.

Exercise Dose and Weight Loss in Adolescents with Overweight-Obesity: A Meta-Regression

BACKGROUND

A recent meta-analysis reported that exercise interventions are effective for promoting weight loss in adolescents with overweight-obesity. However, the meta-analysis did not investigate whether there is an optimal exercise dose for promoting weight loss in overweight and obese adolescents. A common method of expressing exercise dose is the calculation of metabolic equivalents (METs), expressed as MET-h/week.

OBJECTIVES

The objective of this study was to determine the association between exercise dose (MET-h/week) and weight loss [body weight, body mass index (BMI)] in adolescents with overweight-obesity.

DATA SOURCES

Trials included in the original meta-analysis were extracted, and a subsequent search to identify studies published between May 2015 and May 2018 was conducted. The search included electronic databases (PubMed, Web of Science SPORTDiscus, Google Scholar) and the reference lists of eligible articles and relevant reviews.

STUDY SELECTION

The inclusion criteria were as follows: (i) randomized controlled trial; (ii) structured exercise intervention, alone or combined with other intervention components; (iii) control group received no structured exercise or behavioral modification designed to increase physical activity; (iv) participants overweight or obese (BMI ≥ 85th percentile); and (v) participants aged between 10 and 19 years.

APPRAISAL AND SYNTHESIS METHODS

Fifteen trials were extracted from the original meta-analysis. The current search identified an additional five trials (three articles). Data from 20 trials (16 articles) involving 1091 participants (54% female, 17% not reported) were included in the analysis. Effect sizes were reported as mean difference, and random effects meta-regression quantified the association between exercise dose and weight loss. Study quality was assessed using a modified Jadad's scale.

RESULTS

Total body weight change (decrease) ranged from - 2.7 to 19.3 (median 2.5) kg, and BMI change (decrease) ranged from - 1.6 to 6.3 (median 0.9) kg/m². MET-h/week ranged from 5.4 to 36.0 (median 6.0). Each MET-h/week was associated with a 0.13 kg/m² (95% confidence interval [CI] 0.08-0.19) and 0.33 kg (95% CI 0.08-0.59) decrease in BMI and body weight, respectively.

LIMITATIONS

The prescribed exercise dose for the majority of trials was low. As such, we were unable to discern whether there was an optimal exercise dose for weight loss (i.e., if the association between dose and weight loss was non-linear). Additionally, most trials had small sample sizes (median n = 34) and 17 trials had methodological limitations.

CONCLUSIONS

Each MET-h/week was associated with a 0.13 kg/m² and 0.33 kg decrease in BMI and body weight, respectively. While this relationship appears to be linear, i.e., no optimal exercise dose, it should be emphasized that the exercise prescription dose for the majority of trials was low. Subsequent trials, with greater exercise dosage, are required to determine whether there is an 'optimal' dose for promoting weight loss in adolescents with overweight-obesity. However, the current findings lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in this population.

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

OBJECTIVES

Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m², fat mass and per cent body fat) in overweight and obese children and adolescents.

DESIGN

Network meta-analysis of randomised exercise intervention trials.

SETTING

Any setting where a randomised trial could be conducted.

PARTICIPANTS

Overweight and obese male and/or female children and adolescents 2-18 years of age.

INTERVENTIONS

Randomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.

PRIMARY OUTCOMES

Changes in BMI in kg/m², fat mass and per cent body fat.

RESULTS

Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.

CONCLUSIONS

Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.

PROSPERO REGISTRATION NUMBER

CRD42017073103.

Associations of Physical Activity With Survival and Progression in Metastatic Colorectal Cancer: Results From Cancer and Leukemia Group B (Alliance)/SWOG 80405

PURPOSE

Regular physical activity is associated with reduced risk of recurrence and mortality in patients with nonmetastatic colorectal cancer. Its influence on patients with advanced/metastatic colorectal cancer (mCRC) has been largely unexplored.

PATIENTS AND METHODS

We conducted a prospective cohort study nested in Cancer and Leukemia Group B (Alliance)/SWOG 80405 (ClinicalTrials.gov identifier: NCT00265850), a National Cancer Institute-sponsored phase III trial of systemic therapy for mCRC. Within 1 month after therapy initiation, patients were invited to complete a validated questionnaire that reported average physical activity over the previous 2 months. On the basis of responses, we calculated metabolic equivalent task (MET) hours per week to quantify physical activity. The primary end point of the clinical trial and this companion study was overall survival (OS). Secondary end points included progression-free survival (PFS) and first grade 3 or greater treatment-related adverse events. To minimize confounding by poor and declining health, we excluded patients who experienced progression or died within 60 days of activity assessment and used Cox proportional hazards regression analysis to adjust for known prognostic factors, comorbidities, and weight loss.

RESULTS

The final cohort included 1,218 patients. Compared with patients engaged in less than 3 MET hours per week of physical activity, patients engaged in 18 or more MET hours per week experienced an adjusted hazard ratio for OS of 0.85 (95% CI, 0.71 to 1.02; P_Trend = .06) and for PFS of 0.83 (95% CI, 0.70 to 0.99; P_Trend = .01). Compared with patients engaging in less than 9 MET hours per week, patients engaging in 9 or more MET hours per week experienced an adjusted hazard ratio for grade 3 or greater treatment-related adverse events of 0.73 (95% CI, 0.62 to 0.86; P_Trend < .001).

CONCLUSION

Among patients with mCRC in Cancer and Leukemia Group B (Alliance)/SWOG 80405, association of physical activity with OS was not statistically significant. Greater physical activity was associated with longer PFS and lower adjusted risk for first grade 3 or greater treatment-related adverse events.

Effects of Telephone Follow-Up Intervention on %Body Fat, Inflammatory Cytokines, and Oxidative Stress in Obese Hispanic Children

This study investigated whether 10 month telephone follow-up intervention effectively stabilizes reductions in %body fat, and markers of inflammation and oxidative stress obtained from summer camp in obese Hispanic children. Fifty-six obese children (19 SUTI: summer camp and 10 months of follow-up telephone intervention, 18 SU: summer camp intervention only, and 19 CON: no intervention) completed this study. Anthropometric data and blood samples were obtained before (PRE), after 8 weeks of summer camp, and a 10month follow-up telephone intervention to measure markers of inflammation and oxidative stress. Eight weeks of summer camp significantly reduced %body fat, and levels of tumor necrosis factor-alpha, C-reactive protein and 8-hydroxydeoxyguanosine. It also elevated levels of adiponectin and total antioxidant status in SUTI and SU (p < 0.05). However, results of the 10month follow-up measurement were reverted back to PRE in SU, whereas the results for SUTI remained different to PRE (p < 0.05). Results confirm that levels of inflammation and oxidative stress are correlated to changes in %body fat, indicating that fat loss is effective in preventing and managing obesity-associated disorders. It is suggested that a telephone intervention is an effective follow-up tool for stabilizing reductions in %body fat as well as levels of inflammation and oxidative stress that were obtained from an intensive summer camp program in obese Hispanic children.

Effect of exercise on colorectal cancer prevention and treatment

In recent years, because of improved cancer screening, detection and treatment modalities, a rapid increase in the population of colorectal and other cancer survivors has been observed. The increasing population has justified the requirement of preventive strategies such as lifestyle modifications with regard to obesity, physical activity, diet and smoking. Physical activity may prevent approximately 15% of the colon cancers. Furthermore, several observational studies have demonstrated the efficacy and dose-dependent and anti-cancer effects of exercise on decreasing the mortality and risk of recurrence before and after the colorectal cancer (CRC) diagnosis. However, the required exercise dose, type and intensity are yet unclear. The results of randomised prospective studies are expected to determine the optimal amount, type and intensity of exercise and formulate the most appropriate exercise plan and guidelines, according to the requirements and comorbidities of the patients. In addition, recent studies have focused on the molecular and genetic mechanisms underlying the effect of physical activity on disease outcomes and recurrence rates. This review aimed to investigate the effects of physical activity and the biological basis of these effects in preventing the risk and recurrence of CRC and decreasing the hazards of cancer and cancer treatment.

Effect of an 8-Week Individualized Training Program on Blood Biomarkers, Adipokines and Endothelial Function in Obese Young Adolescents with and without Metabolic Syndrome

Obesity is a chronic condition whose incidence is growing due to lack of exercise and frequent nutrition disorders. Childhood obesity has reached epidemic proportions worldwide. One of the best treatment methods is physical training. However, conflicting results have been reported regarding its clinical effectiveness. These contrasting findings may be due to the type and intensity of the adopted physical training program. Therefore, the purpose of the current study was to investigate the effect of an 8-week individualized physical training program on endothelial function, blood biomarkers and adipokine levels in obese adolescents with and without metabolic syndrome (MS). One-hundred-and-twenty-two obese adolescents (71 obese without MS and 51 obese with MS) aged 14 ± 2 years were included in this study. The 8-week individualized training program decreased glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol and leptin in obese subjects with and without MS. However, adiponectin and endothelial-dependent vasodilatation increased in the follow-up study in both groups. Taken together, the findings suggest that individualized training program is an effective means for the treatment of obesity and MS in pediatric populations.

Does Physical Activity-Based Intervention Improve Systemic Proinflammatory Cytokine Levels in Overweight or Obese Children and Adolescents? Insights from a Meta-Analysis of Randomized Control Trials

OBJECTIVES

The purpose of this research was to conduct a meta-analysis of the role that physical activity (PA) plays in influencing the critical proinflammatory cytokine levels associated with overweight/obese children and adolescents to explore the effectiveness of exercise intervention within this population.

METHODS

With searches of the PubMed, EMBASE, and CENTRAL databases, we updated our meta-analysis up to November 2018. The randomized controlled trials (RCT) evaluated the ability of exercise training to increase the following factors in children and/or adolescents classified as obese or overweight: tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP).

RESULTS

Eleven RCT comprising 623 children and/or adolescents who were obese or overweight (i.e., 393 with PA and 230 controls) were suitable for use in this study. The meta-analysis showed that PA in general was associated with a significant reduction of CRP levels (mean difference = -0.45 mg/L, p = 0.02) in overweight/obese children and adolescents. Based on 115 overweight and obese youths, this study suggests that PA does not significantly mitigate IL-6 levels (mean difference = -0.39 pg/mL, p = 0.08), although there was a trend towards a reduction. Additionally, no close connection was observed between PA and TNF-α levels at 0.04 pg/mL (p = 0.78). Moreover, meta-regression analysis revealed a statistical association between CPR levels and changes in BMI or changes in adiponectin; likewise, IL-6 levels dramatically impacted the effect of exercise on changes in adiponectin.

CONCLUSIONS

PA was associated with significantly reduced CRP levels, whereas there was no significant association with IL-6 or TNF-α in overweight/obese children or adolescents; however, there was a trend towards a reduction of IL-6.

Comparison of the effect of two therapeutic exercises on the inflammatory and physiological conditions and complications of diabetic neuropathy in female patients

INTRODUCTION AND AIM

The purpose of this study was to compare the effect of 12 weeks of low-intensity resistance training and exercises for peripheral neuropathy (EPN) on the inflammatory and physiological conditions, balance, and complications of diabetic neuropathy in female patients.

MATERIALS AND METHODS

45 women with mild to moderate diabetic neuropathy and an average age of 55.46±3.06 years voluntarily participated in the study. They were randomly assigned to either control (n=15), resistance (n=15), and EPN (n=15) groups. Both experimental groups were trained for 12 weeks (three sessions per week). EPN group did peripheral neuropathic exercises (12 lower extremity movements), and the resistance group performed their exercises with a 30% repetition maximum. During the intervention period, the control group only performed their daily activities. Blood samples were taken in both pre-test and post-test to investigate the levels of Tumor necrosis-α (TNF-α), Interleukin-10 (IL-10), C Reactive Protein (CRP), fast blood glucose (FBG) and Glycated hemoglobin (HbA1c). Complications of diabetic neuropathy were measured using the Michigan questionnaire and the Monofilament 10 g. In order to measure the balance, De Morton mobility index (DEMMI) was used.

RESULTS

The statistical analyses showed a significant decrease of FBG and HbA1c in the two experimental groups, as compared to the control group. TNF-α and CRP levels were decreased in both EPN and resistance groups, as compared to the control group. The observed increase in the serum IL-10 levels of the two experimental groups was not, however, significant, as shown in intra-group and inter-group comparisons. On the other hand, the two complications of pain and tingling in the lower limb extremities were improved in both experimental groups (p<0.05). However, the numbness complication showed no significant change (p=0.10). Static and dynamic balance was improved in the EPN group as well (p<0.05).

CONCLUSION

Since EPN exercises, in contrast to resistance exercises, are focused on the lower limb extremities and designed for diabetic neuropathy patients, they can improve the imbalance, pain and tingling, by significantly reducing TNF-α and CRP and improving the physiological conditions.

Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies

Resting heart rate (RHR) is positively related with mortality. Regular exercise causes a reduction in RHR. The aim of the systematic review was to assess whether regular exercise or sports have an impact on the RHR in healthy subjects by taking different types of sports into account. A systematic literature research was conducted in six databases for the identification of controlled trials dealing with the effects of exercise or sports on the RHR in healthy subjects was performed. The studies were summarized by meta-analyses. The literature search analyzed 191 studies presenting 215 samples fitting the eligibility criteria. 121 trials examined the effects of endurance training, 43 strength training, 15 combined endurance and strength training, 5 additional school sport programs. 21 yoga, 5 tai chi, 3 qigong, and 2 unspecified types of sports. All types of sports decreased the RHR. However, only endurance training and yoga significantly decreased the RHR in both sexes. The exercise-induced decreases of RHR were positively related with the pre-interventional RHR and negatively with the average age of the participants. From this, we can conclude that exercise-especially endurance training and yoga-decreases RHR. This effect may contribute to a reduction in all-cause mortality due to regular exercise or sports.