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Bines K, Strehlow E, Gray E, Nettnin E, Stoff L, Rafferty MR. Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation. PM R 2024; 16:426-433. [PMID: 37817058 DOI: 10.1002/pmrj.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. DESIGN A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. SETTING IRF. PARTICIPANTS Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. MAIN OUTCOME MEASURES Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. RESULTS Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. CONCLUSIONS Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.
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Affiliation(s)
- Kelcey Bines
- Shirley Ryan Ability Lab, Chicago, United States
| | | | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Ella Nettnin
- Shirley Ryan Ability Lab, Chicago, United States
| | - Laura Stoff
- Shirley Ryan Ability Lab, Chicago, United States
| | - Miriam R Rafferty
- Shirley Ryan Ability Lab, Chicago, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States
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Rees M, Collins CE, Majellano EC, McDonald VM. Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study. J Multidiscip Healthc 2023; 16:3339-3355. [PMID: 38024134 PMCID: PMC10640832 DOI: 10.2147/jmdh.s421520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified. Purpose The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital. Methods Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF). Results Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease. Conclusion This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.
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Affiliation(s)
- Merridie Rees
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Eleanor C Majellano
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Buriticá-Marín ED, Daza-Arana JE, Jaramillo-Losada J, Riascos-Zuñiga AR, Ordoñez-Mora LT. Effects of a Physical Exercise Program on the Physical Capacities of Older Adults: A Quasi-Experimental Study. Clin Interv Aging 2023; 18:273-282. [PMID: 36851976 PMCID: PMC9960785 DOI: 10.2147/cia.s388052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/14/2022] [Indexed: 02/23/2023] Open
Abstract
Purpose To measure the effects of an exercise program on the physical capacities of older adults such as strength, flexibility, balance, and aerobic capacity. Patients and Methods This was a quasi-experimental study on a population of 5550 older adults and a sample of 4830 participants in an active aging program designed by the Municipal Health Secretary. The exercise program lasted 12 months, and pre-and post-program intervention measures were recorded using the senior fitness test. Results Most participants were women (92.4%) and their mean age was 70.7 years (standard deviation, 7.3 years; range, 60-97 years). All areas showed significant differences before and after the program in terms of the participants' physical capabilities (p < 0.05), muscular strength and flexibility had a more significant mean difference and a large effect (>0.80), except for aerobic capacity, which had a small effect. Conclusion The present study revealed that a supervised physical exercise program at the community level has positive effects on the physical capacities of coordination, balance, flexibility, strength, and aerobic capacity, which are essential components for a better functional capacity at this stage of life, with improvements that encompassed the improved self-perception of their health status, a reduction of overweight and obesity. The reinforcement of these programs is recommended, consequently, promoting pre-sport games and sports championships among the elderly population, as a public health strategy.
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Gasparri C, Perna S, Peroni G, Riva A, Petrangolini G, Faliva MA, Naso M, Rondanelli M. Multidisciplinary residential program for the treatment of obesity: how body composition assessed by DXA and blood chemistry parameters change during hospitalization and which variations in body composition occur from discharge up to 1-year follow-up. Eat Weight Disord 2022; 27:2701-2711. [PMID: 35648314 PMCID: PMC9556418 DOI: 10.1007/s40519-022-01412-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Obesity is a chronic disease characterized by a complex variable clinical presentation with comorbidities. A multidisciplinary residential program (MRP) represents one of the best options for treating obesity. The purpose of this study was to evaluate the effectiveness of 8-week MRP on weight loss, body composition assessed by DXA, and metabolic blood parameters between entry (T0) and discharge (T1). The secondary endpoint was the evaluation of the patients' adherence to diet during the check-up outpatient visits, at 2 (T2), 6 (T3), and 12 (T4) months after discharge. METHODS 168 subjects were enrolled (61 males and 117 females, aged 58.5 ± 13 years, BMI 41.3 ± 6 kg/m2) in the study. The difference in values (end of hospitalization compared to baseline) was calculated through the univariate analysis procedure, which provides regression analysis and analysis of variance for a variable dependent on one or more variables. RESULTS There was a statistically significant improvement of all parameters investigated: total mass (- 5.68 kg), fat mass (- 4416.85 g), fat mass index (- 1724.56), visceral adipose tissue (- 332.76 g), arm circumference (- 1.63 cm) and calf circumference (- 1.16 cm). As it is reasonable to expect, even the fat free mass has been reduced (- 1236.03 g); however, the skeletal muscle index was not affected. Statistically significant improvement in glycaemic and lipid profile were reported. The BMI average reduction continued from discharge until T4. No statistically significant changes in fat free mass and visceral adipose tissue (VAT) were reported during a year of follow-up. CONCLUSIONS The present study demonstrated the clinical benefits of 8-week MRP, which includes hypocaloric diet, physical exercise, and psychological support. LEVEL OF EVIDENCE III, evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100, Pavia, Italy.
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038, Zallaq, Kingdom of Bahrain
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100, Pavia, Italy
| | - Antonella Riva
- Research and Development Unit, Indena, 20139, Milan, Italy
| | | | - Milena Anna Faliva
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100, Pavia, Italy
| | - Maurizio Naso
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, 27100, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy.,IRCCS Mondino Foundation, 27100, Pavia, Italy
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Spadaccini D, Guazzotti S, Goncalves Correia FP, Daffara T, Tini S, Antonioli A, Aimaretti G, Marzullo P, Caputo M, Antoniotti V, Prodam F. Beyond bariatric surgery and weight loss medicaments. A systematic review of the current practice in obesity rehabilitative inpatient programs in adults and pediatrics. Front Nutr 2022; 9:963709. [PMID: 36245519 PMCID: PMC9556721 DOI: 10.3389/fnut.2022.963709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background Obesity treatment strategies mainly include outpatient lifestyle modification, drugs and bariatric surgery. Voluntary rehabilitative inpatient programs are gaining relevance as potential alternative settings of care that focus on weight loss and prevention of weight regain through a multidisciplinary approach, but their prevalence is still limited due to the high costs. Aim Considering the lack of evidence in this area, the objective of this study is to systematically review the currently available literature on non-pharmacological and non-surgical inpatient programs aimed at weight loss, to clarify the efficacy and the characteristics of these interventions. Methods Proper English language articles from 2000 to 2022 were searched on relevant databases. Quality assessment was performed by two different authors using ROB2 and robvis tools. Adult and pediatric studies were reviewed separately and their characteristics were systematically displayed. Results 36 articles were included (20 on adults, 16 on children, and adolescents) for a total of 5,510 individuals. The multidisciplinary approach was mainly comprehensive of a low-calorie diet, scheduled physical activity, and psychological support based on behavioral treatment. Educational and cooking sessions were present at a lower rate. Globally, inpatient weight loss programs showed a consistent efficacy in reducing body weight and inducing beneficial effects on quality of life, psychological well-being, eating behavior, physical performance, and fatigue. Follow-up data were scarce, but with a high percentage of patients regaining weight after a short period. Conclusion Weight loss inpatient rehabilitation is a promising area that has evidence of all-rounded success in the amelioration of several aspects related to obesity. Nevertheless, it appears to be quite inconsistent in preserving these benefits after the intervention. This might slow the innovation process in this area and preclude further investments from national healthcare. Personalized and enriched programs could show greater impact when focusing on the behavioral and educational aspects, which are crucial points, in particular in pediatrics, for setting up a long-lasting lifestyle modification. More studies are therefore necessary to evaluate long-term efficacy based on the different work-up models.
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Affiliation(s)
- Daniele Spadaccini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Silvia Guazzotti
- Biological Mass Spectrometry Lab, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Tommaso Daffara
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Sabrina Tini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Division of General Medicine, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Verbania, Italy
| | - Marina Caputo
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valentina Antoniotti
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- *Correspondence: Flavia Prodam,
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The Evaluation of Functional Abilities Using the Modified Fullerton Functional Fitness Test Is a Valuable Accessory in Diagnosing Men with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159210. [PMID: 35954574 PMCID: PMC9367744 DOI: 10.3390/ijerph19159210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
The assessment of functional abilities reflects the ability to perform everyday life activities that require specific endurance and physical fitness. The Fullerton functional fitness test (FFFT) seems to be the most appropriate for assessing physical fitness in heart failure (HF) patients. The study group consisted of 30 consecutive patients hospitalized for the routine assessment of HF with a reduced ejection fraction (HFrEF). They formed the study group, and 24 healthy subjects formed the control group. Each patient underwent a cardiopulmonary exercise test (CPET), transthoracic echocardiography and FFFT modified by adding the measurement of the handgrip force of the dominant limb with the digital dynamometer. The HF patients had significantly lower peak oxygen uptake (peakVO2), maximal minute ventilation, and higher ventilatory equivalent (VE/VCO2). The concentrations of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were significantly higher in the study group. The results of all the FFFT items were significantly worse in the study group. FFFT parameters, together with the assessment of the strength of the handgrip, strongly correlated with the results of standard tests in HF. FFFT is an effective and safe tool for the functional evaluation of patients with HFrEF. Simple muscle strength measurement with a hand-held dynamometer can become a convenient and practical indicator of muscle strength in HF patients.
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7
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Wakabayashi H, Yoshimura Y, Maeda K, Fujiwara D, Nishioka S, Nagano A. Goal setting for nutrition and body weight in rehabilitation nutrition: position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication). J Gen Fam Med 2022; 23:77-86. [PMID: 35261854 PMCID: PMC8888801 DOI: 10.1002/jgf2.509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022] Open
Abstract
The most important nutrition goals in rehabilitation nutrition are improving function and quality of life, and they are useful to set body weight goals to further improve these aspects. In this paper, we clarified our position, as the Japanese Association of Rehabilitation Nutrition, on body weight goal setting. Body weight goals should be SMART (Specific, Measurable, Achievable, Realistic/Relevant, and Timed). The standard amount of energy accumulation/deficit needed to gain/lose 1 kg body weight is 7500 kcal. In other words, if the nutrition goal is set at 1 kg body weight gain per month, daily energy accumulation can be calculated as approximately 250 kcal. It is necessary to reconcile the rehabilitation goal setting, the content, quantity, and quality of physical activity and exercise therapy, and the patient's general condition and intentions to set nutrition goals. Body weight goal setting is more variable than rehabilitation goal setting, and it is important to confirm the degree of achievement through rehabilitation nutrition monitoring.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition ResearchKumamoto Rehabilitation HospitalKumamotoJapan
| | - Keisuke Maeda
- Department of Geriatric MedicineNational Center for Geriatrics and GerontologyObuJapan
| | - Dai Fujiwara
- Department of Rehabilitation MedicineSaka General HospitalShiogamaJapan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food ServicesNagasaki Rehabilitation HospitalNagasakiJapan
| | - Ayano Nagano
- Department of NursingNishinomiya Kyoritsu Neurosurgical HospitalNishinomiyaJapan
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8
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Bughin F, Bui G, Ayoub B, Blervaque L, Saey D, Avignon A, Brun JF, Molinari N, Pomies P, Mercier J, Gouzi F, Hayot M. Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28242. [PMID: 34874887 PMCID: PMC8691412 DOI: 10.2196/28242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/10/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients’ adhesion, and satisfaction. Results A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: −0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: −1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients’ adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666
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Affiliation(s)
- François Bughin
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Gaspard Bui
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Bronia Ayoub
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Leo Blervaque
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Antoine Avignon
- Institut Desbrest de Santé Publique, University of Montpellier, Institut national de la santé et de la recherche médicale, Montpellier, France.,Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Jean Frédéric Brun
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Nicolas Molinari
- Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Centre national de la recherche scientifique, Montpellier, France.,Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Pascal Pomies
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
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Rees M, Collins CE, De Vlieger N, McDonald VM. Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review. Diabetes Metab Syndr Obes 2021; 14:417-429. [PMID: 33564249 PMCID: PMC7866939 DOI: 10.2147/dmso.s280735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Adult inpatients with Class II or III obesity and comorbidities have a high health burden with frequent hospitalizations. Surgical risk and patient choice can be contraindications to bariatric surgery, which is considered the gold standard treatment. The best approach to non-surgical management for this adult inpatient group is currently unknown. The aim of this scoping review was to summarize current research in the inpatient setting. The unpublished literature and six electronic database searches identified 4,582 articles, with 12 articles (reporting on 10 studies) eligible and included. The literature on the interventions and their key components in the non-surgical care of the adult inpatient with Class II or III obesity were mapped identifying service provision successes and gaps. The articles reported on intensive lifestyle interventions, comparison of oxygen administration regimes, total parenteral nutrition regimens, and pre-surgical rapid weight loss. Study designs included evaluation (n=1), before-after intervention studies (n=3), and randomized/non-randomized controlled trials (n=6). The classification of obesity as a chronic disease is not universal resulting in reduced inpatient treatment options. Recommendations for consumers, practitioner practice, health policy-makers and future research priorities are reported. Further research in the development of cost-effective inpatient models of care is indicated.
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Affiliation(s)
- Merridie Rees
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Priority Research Centre for Healthy Lungs and the School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition and the School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Nienke De Vlieger
- Priority Research Centre for Physical Activity and Nutrition and the School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Priority Research Centre for Healthy Lungs and the School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Correspondence: Vanessa M McDonald School of Nursing and Midwifery, The University of Newcastle, Locked Bag 1000, New Lambton, NSW, 2305, AustraliaTel +61 2 40420146Fax +61 2 40420046 Email
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Sanchis-Soler G, Tortosa-Martínez J, Manchado-Lopez C, Cortell-Tormo JM. The effects of stress on cardiovascular disease and Alzheimer's disease: Physical exercise as a counteract measure. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 152:157-193. [PMID: 32450995 DOI: 10.1016/bs.irn.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AD is a complicated multi-systemic neurological disorder that involves different biological pathways. Several risk factors have been identified, including chronic stress. Chronic stress produces an alteration in the activity of the hypothalamic pituitary adrenal (HPA) system, and the autonomic nervous system (ANS), which over time increase the risk of AD and also the incidence of cardiovascular disease (CVD) and risk factors, such as hypertension, obesity and type 2 diabetes, associated with cognitive impairment and AD. Considering the multi-factorial etiology of AD, understanding the complex interrelationships between different risk factors is of potential interest for designing adequate strategies for preventing, delaying the onset or slowing down the progression of this devastating disease. Thus, in this review we will explore the general mechanisms and evidence linking stress, cardiovascular disease and AD, and discuss the potential benefits of physical activity for AD by counteracting the negative effects of chronic stress, CVD and risk factors.
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