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Lang JE, Carrion VM, Bhammar DM, Howard JB, Armstrong SC. A Randomized Trial of Inspiratory Training in Children and Adolescents With Obesity. Child Obes 2024. [PMID: 38696657 DOI: 10.1089/chi.2023.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Introduction: Children with obesity suffer excess dyspnea that contributes to sedentariness. Developing innovative strategies to increase exercise tolerance and participation in children with obesity is a high priority. Because inspiratory training (IT) has reduced dyspnea, we sought to assess IT in children with obesity. Methods: We conducted a 6-week randomized IT trial involving 8- to 17-year-olds with obesity. Participants were randomized 1:1 to either high [75% of maximal inspiratory pressure (MIP)] or low resistance control (15% of MIP) three times weekly. Assessments included adherence, patient satisfaction, and changes in inspiratory strength and endurance, dyspnea scores and total activity level. Results: Among 27 randomized, 24 (89%) completed the intervention. Total session adherence was 72% which did not differ between treatment groups. IT was safe, and more than 90% felt IT benefitted breathing and general health. IT led to a mean improvement (95% CI) in inspiratory strength measured by MIP of 10.0 cm H2O (-3.5, 23.6; paired t-test, p = 0.139) and inspiratory endurance of 8.9 (1.0, 16.8; paired t-test, p = 0.028); however, there was no significant difference between high- and low-treatment groups. IT led to significant reductions in dyspnea with daily activity (p < 0.001) and in prospectively reported dyspnea during exercise (p = 0.024). Among the high- versus low-treatment group, we noted a trend for reduced dyspnea with daily activity (p = 0.071) and increased daily steps (865 vs. -51, p = 0.079). Discussion: IT is safe and feasible for children with obesity and holds promise for reducing dyspnea and improving healthy activity in children with obesity. Breathe-Fit trial NCT05412134.
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Affiliation(s)
- Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Veronica M Carrion
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Dharini M Bhammar
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Janna B Howard
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Sarah C Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Mohammed Yusuf SF, Bhise A, Nuhmani S, Alghadir AH, Khan M. Effects of an incentive spirometer versus a threshold inspiratory muscle trainer on lung functions in Parkinson's disease patients: a randomized trial. Sci Rep 2023; 13:2516. [PMID: 36781936 PMCID: PMC9925741 DOI: 10.1038/s41598-023-29534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Upper airway obstruction, reduced maximal expiratory and inspiratory flows, reduced lung volumes, abnormal ventilatory control, and diaphragmatic dyskinesias are reported in patients with Parkinson's disease (PD). Inspiratory muscle training (IMT) has been reported to be effective in improving respiratory functions; however, no studies have compared the effects of the incentive spirometer (IS) with the threshold inspiratory muscle trainer (TIMT) in patients with PD. The study aimed to compare the effects of IS and TIMT on maximum inspiratory pressure (MIP), 6-min walk distance (6-MWD), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) in patients with stage 1-3 according to the Hoehn and Yahr scale. 18 patients were randomly assigned to two groups, i.e., incentive spirometer (IS) and threshold inspiratory muscle trainer (TIMT) group. The IS group received IMT with volume-based IS, and the TIMT group received IMT with TIMT. MIP, 6-MWD, FVC, FEV1, and PEFR were measured before and after six weeks of training. In IS group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 18.13 and 5%, respectively. In the TIMT group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 30.15 and 8.94%, respectively. Both groups observed no significant difference (p > 0.05) in FVC, FEV1, and PEFR. When the two groups were compared, a greater increase (p < 0.05) was observed in the MIP and 6-MWD in the TIMT group compared to IS group. IMT with IS or TIMT for six weeks effectively increased MIP and 6-MWD in patients with stage 1-3 (Hoehn and Yahr scale) of PD. No improvement was observed in FVC, FEV1, or PEFR with any of the techniques. TIMT is more effective than IS in improving MIP and 6-MWD.
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Affiliation(s)
| | - Anjali Bhise
- Government Physiotherapy College, Government Spine Institute, Civil Hospital, Ahmedabad, Gujarat, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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Salvadego D, Tringali G, De Micheli R, Sartorio A. Respiratory Muscle Interval Training Improves Exercise Capacity in Obese Adolescents during a 3-Week In-Hospital Multidisciplinary Body Weight Reduction Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:487. [PMID: 36612808 PMCID: PMC9819313 DOI: 10.3390/ijerph20010487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to determine whether a novel approach of interval training targeted to the respiratory muscles (RMIT; normocapnic hyperpnea with resistance) in addition to a multidisciplinary in-hospital body weight reduction program (BWRP) was able to improve the integrative response to exercise in young patients with obesity. Nine male patients (17.9 ± 4.9 (x ± SD) years; 113.8 ± 16.3 kg) underwent 12 sessions of RMIT and eight age-and sex-matched patients underwent 12 sessions of a sham protocol (CTRL) during the same 3-week BWRP. Before and after the interventions the patients performed an incremental and a heavy-intensity constant work-rate (CWR>GET) cycling exercise to voluntary exhaustion. Body mass decreased by ~4.0 kg after both RMIT (p = 0.0001) and CTRL (p = 0.0002). Peak pulmonary O2 uptake (V˙O2) increased after RMIT (p = 0.02) and CTRL (p = 0.0007). During CWR>GET at ISO-time, V˙O2 (p = 0.0007), pulmonary ventilation (p = 0.01), heart rate (p = 0.02), perceived respiratory discomfort (RPER; p = 0.03) and leg effort (p = 0.0003) decreased after RMIT; only RPER (p = 0.03) decreased after CTRL. Time to exhaustion increased after RMIT (p = 0.0003) but not after CTRL. In young patients with obesity, RMIT inserted in a 3-week BWRP reduced the cardiorespiratory burden, the metabolic cost, the perceived effort, and improved exercise tolerance during heavy-intensity cycling.
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Kelley RC, Lapierre SS, Muscato DR, Hahn D, Christou DD, Ferreira LF. Cardiac and respiratory muscle responses to dietary N-acetylcysteine in rats consuming a high-saturated fat, high-sucrose diet. Exp Physiol 2022; 107:1312-1325. [PMID: 35938289 PMCID: PMC9633399 DOI: 10.1113/ep090332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/22/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? This study addresses whether a high-fat, high-sucrose diet causes cardiac and diaphragm muscle abnormalities in male rats and whether supplementation with the antioxidant N-acetylcysteine reverses diet-induced dysfunction. What is the main finding and its importance? N-Acetylcysteine attenuated the effects of high-fat, high-sucrose diet on markers of cardiac hypertrophy and diastolic dysfunction, but neither high-fat, high-sucrose diet nor N-acetylcysteine affected the diaphragm. These results support the use of N-acetylcysteine to attenuate cardiovascular dysfunction induced by a 'Western' diet. ABSTRACT Individuals with overweight or obesity display respiratory and cardiovascular dysfunction, and oxidative stress is a causative factor in the general aetiology of obesity and of skeletal and cardiac muscle pathology. Thus, this preclinical study aimed to define diaphragmatic and cardiac morphological and functional alterations in response to an obesogenic diet in rats and the therapeutic potential of an antioxidant supplement, N-acetylcysteine (NAC). Young male Wistar rats consumed ad libitum a 'lean' or high-saturated fat, high-sucrose (HFHS) diet for ∼22 weeks and were randomized to control or NAC (2 mg/ml in the drinking water) for the last 8 weeks of the dietary intervention. We then evaluated diaphragmatic and cardiac morphology and function. Neither HFHS diet nor NAC supplementation affected diaphragm-specific force, peak power or morphology. Right ventricular weight normalized to estimated body surface area, left ventricular fractional shortening and posterior wall maximal shortening velocity were higher in HFHS compared with lean control animals and not restored by NAC. In HFHS rats, the elevated deceleration rate of early transmitral diastolic velocity was prevented by NAC. Our data showed that the HFHS diet did not compromise diaphragmatic muscle morphology or in vitro function, suggesting other possible contributors to breathing abnormalities in obesity (e.g., abnormalities of neuromuscular transmission). However, the HFHS diet resulted in cardiac functional and morphological changes suggestive of hypercontractility and diastolic dysfunction. Supplementation with NAC did not affect diaphragm morphology or function but attenuated some of the cardiac abnormalities in the rats receiving the HFHS diet.
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Affiliation(s)
- Rachel C. Kelley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Stephanie S. Lapierre
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Derek R. Muscato
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Dongwoo Hahn
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Demetra D. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Leonardo F. Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
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Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence? Can Respir J 2022; 2022:5680311. [PMID: 36033343 PMCID: PMC9410970 DOI: 10.1155/2022/5680311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Pulmonary rehabilitation is typically used for reducing respiratory symptoms and improving fitness and quality of life for patients with chronic lung disease. However, it is rarely prescribed and may be underused in pediatric conditions. Pulmonary rehabilitation can include inspiratory muscle training that improves the strength and endurance of the respiratory muscles. The purpose of this narrative review is to summarize the current literature related to inspiratory muscle rehabilitation training (IMRT) in healthy and diseased pediatric populations. This review highlights the different methods of IMRT and their effects on respiratory musculature in children. Available literature demonstrates that IMRT can improve respiratory muscle strength and endurance, perceived dyspnea and exertion, maximum voluntary ventilation, and exercise performance in the pediatric population. These mechanistic changes help explain improvements in symptomology and clinical outcomes with IMRT and highlight our evolving understanding of the role of IMRT in pediatric patients. There remains considerable heterogeneity in the literature related to the type of training utilized, training protocols, duration of the training, use of control versus placebo, and reported outcome measures. There is a need to test and refine different IMRT protocols, conduct larger randomized controlled trials, and include patient-centered clinical outcomes to help improve the evidence base and support the use of IMRT in patient care.
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Kaeotawee P, Udomittipong K, Nimmannit A, Tovichien P, Palamit A, Charoensitisup P, Mahoran K. Effect of Threshold Inspiratory Muscle Training on Functional Fitness and Respiratory Muscle Strength Compared to Incentive Spirometry in Children and Adolescents With Obesity: A Randomized Controlled Trial. Front Pediatr 2022; 10:942076. [PMID: 35874588 PMCID: PMC9302609 DOI: 10.3389/fped.2022.942076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To determine the effect of threshold inspiratory muscle training (IMT) on functional fitness and respiratory muscle strength (RMS) compared to incentive spirometry (IS) in children/adolescents with obesity. METHODS A total of 60 obese children/adolescents aged 8-15 years were randomized into the threshold IMT group (n = 20), the IS group (n = 20), or the control group (n = 20). The IMT group performed 30 inspiratory breaths with the intensity set at 40% of baseline maximal inspiratory pressure (MIP) twice daily for 8 weeks; the IS group performed 30 breaths with sustained maximum inspiration twice daily for 8 weeks; and, the control group was assigned no training device for 8 weeks. Six-min walk test (6-MWT), RMS, and spirometry were compared between baseline and 8 weeks. RESULTS Six-MWT distance (528.5 ± 36.2 vs. 561.5 ± 35.2 m, p = 0.002) and MIP (121.2 ± 26.8 vs. 135.3 ± 32.1%Predicted, p = 0.03) were significantly improved after 8 weeks of IMT training. There was no significant difference in any evaluated pulmonary function parameters between baseline and 8 weeks in the IS or control groups; however, 6-MWT distance demonstrated a trend toward significant improvement in the IS group (526.9 ± 59.1 vs.549.0 ± 50.6 m, p = 0.10). No significant difference among groups was found for any variable relative to change from baseline to post-training. CONCLUSION Eight weeks of threshold IMT training significantly improved both inspiratory muscle strength (MIP) and functional fitness (6-MWT) in children/adolescents with obesity. Eight weeks of IS training yielded a trend toward significantly improved functional fitness.
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Affiliation(s)
- Phatthareeda Kaeotawee
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarin Nimmannit
- Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apinya Palamit
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Charoensitisup
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khunphon Mahoran
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kuo YC, Chang HL, Cheng CF, Mündel T, Liao YH. Six-week inspiratory resistance training ameliorates endurance performance but does not affect obesity-related metabolic biomarkers in obese adults: A randomized controlled trial. Respir Physiol Neurobiol 2020; 273:103285. [DOI: 10.1016/j.resp.2019.103285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/05/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
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Alemayehu HK, Salvadego D, Isola M, Tringali G, De Micheli R, Caccavale M, Sartorio A, Grassi B. Three weeks of respiratory muscle endurance training improve the O 2 cost of walking and exercise tolerance in obese adolescents. Physiol Rep 2018; 6:e13888. [PMID: 30350405 PMCID: PMC6198139 DOI: 10.14814/phy2.13888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022] Open
Abstract
Obese adolescents (OB) have an increased O2 cost of exercise, attributable in part to an increased O2 cost of breathing. In a previous work a short (3-week) program of respiratory muscle endurance training (RMET) slightly reduced in OB the O2 cost of high-intensity cycling and improved exercise tolerance. We hypothesized that during treadmill walking the effects of RMET would be more pronounced than those observed during cycling. Sixteen OB (age 16.0 ± 0.8 years; body mass [BM] 127.7 ± 14.2 kg; body mass index 40.7 ± 4.0 kg/m2 ) underwent to 3-week RMET (n = 8) superimposed to a multidisciplinary BM reduction program, or (CTRL, n = 8) only to the latter. Heart rate (HR) and pulmonary O2 uptake ( V ˙ O2 ) were measured during incremental exercise and 12-min constant work rate (CWR) walking at 60% (moderate-intensity, MOD) and 120% (heavy-intensity, HEAVY) of the gas exchange threshold (GET). The O2 cost of walking (aerobic energy expenditure per unit of covered distance) was calculated as V ˙ O2 /velocity. BM decreased (~4-5 kg) both in CTRL and in RMET. V ˙ O2 peak and GET were not affected by both interventions; the time to exhaustion increased following RMET. During MOD and HEAVY RMET decreased V ˙ O2, the O2 cost of walking (MOD: 0.130 ± 0.033 mL/kg/m [before] vs. 0.109 ± 0.027 [after], P = 0.03; HEAVY: 0.196 ± 0.031 [before] vs. 0.180 ± 0.025 [after], P = 0.02), HR and rates of perceived exertion; no significant changes were observed in CTRL. In OB a short RMET program lowered the O2 cost of MOD and HEAVY walking and improved exercise tolerance. RMET could represent a useful adjunct in the control of obesity.
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Affiliation(s)
| | | | - Miriam Isola
- Department of MedicineUniversity of UdineUdineItaly
| | - Gabriella Tringali
- Istituto Auxologico ItalianoIRCCSExperimental Laboratory for Auxo‐endocrinological ResearchMilan and Piancavallo (VB)Italy
| | - Roberta De Micheli
- Istituto Auxologico ItalianoIRCCSExperimental Laboratory for Auxo‐endocrinological ResearchMilan and Piancavallo (VB)Italy
| | - Mara Caccavale
- Istituto Auxologico ItalianoIRCCSExperimental Laboratory for Auxo‐endocrinological ResearchMilan and Piancavallo (VB)Italy
| | - Alessandro Sartorio
- Istituto Auxologico ItalianoIRCCSExperimental Laboratory for Auxo‐endocrinological ResearchMilan and Piancavallo (VB)Italy
- Division of Metabolic Diseases and AuxologyIstituto Auxologico ItalianoIRCCSPiancavallo (VB)Italy
| | - Bruno Grassi
- Department of MedicineUniversity of UdineUdineItaly
- Institute of Bioimaging and Molecular PhysiologyNational Research CouncilMilanItaly
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Phillips CL, Cayanan EA, Hoyos CM. Cardiopulmonary rehabilitation for obese sleep-disordered breathing: a new treatment frontier? Thorax 2018; 73:thoraxjnl-2018-211607. [PMID: 29572270 DOI: 10.1136/thoraxjnl-2018-211607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Craig L Phillips
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth A Cayanan
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
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Salvadego D, Sartorio A, Agosti F, Tringali G, Patrizi A, Isola M, LoMauro A, Aliverti A, Grassi B. Respiratory muscle endurance training reduces the O2 cost of cycling and perceived exertion in obese adolescents. Am J Physiol Regul Integr Comp Physiol 2017; 313:R487-R495. [DOI: 10.1152/ajpregu.00396.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022]
Abstract
In obesity, the increased O2 cost of breathing negatively affects the O2 cost of exercise and exercise tolerance. The purpose of the study was to determine whether, in obese adolescents, the addition of respiratory muscle endurance training (RMET) (isocapnic hyperpnea) to a standard body mass reduction program decreases the O2 cost of exercise and perceived exertion. Nine male obese adolescents [16.0 ± 1.4 yr ( x ± SD), body mass 114.4 ± 22.3 kg] underwent 3 wk of RMET (5 days/week) in addition to a standard body mass reduction program. Eight age- and sex-matched obese adolescents underwent only the standard program (CTRL). Before and after interventions, patients performed on a cycle ergometer: incremental exercise; 12-min exercises at a constant work rate (CWR) of 65% and 120% at the gas exchange threshold (GET) determined before the intervention. Breath-by-breath pulmonary ventilation (V̇e) and O2 uptake (V̇o2), heart rate (HR), and ratings of perceived exertion for dyspnea/respiratory discomfort (RPER) and leg effort (RPEL) were determined. Body mass decreased (by ~3.0 kg) after both RMET ( P = 0.003) and CTRL ( P = 0.002). Peak V̇o2 was not affected by both interventions. Peak work rate was slightly, but significantly ( P = 0.04), greater after RMET but not after CTRL. During CWR < GET, no changes were observed after both interventions. During CWR > GET, the O2 cost of cycling at the end of exercise ( P = 0.02), the slope of V̇o2 vs. time (3–12 min) ( P = 0.01), RPER ( P = 0.01), and RPEL ( P = 0.01) decreased following RMET, but not following CTRL. HR decreased after both RMET ( P = 0.02) and CTRL ( P = 0.03), whereas V̇e did not change. In obese adolescents RMET, superimposed on a standard body mass reduction program, lowered the O2 cost of cycling and perceived exertion during constant heavy-intensity exercise.
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Affiliation(s)
- Desy Salvadego
- Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Metabolic Diseases and Auxology, Piancavallo, Italy
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Milan and Piancavallo, Italy
| | - Fiorenza Agosti
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Milan and Piancavallo, Italy
| | - Gabriella Tringali
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Milan and Piancavallo, Italy
| | - Alessandra Patrizi
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Milan and Piancavallo, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Antonella LoMauro
- Department of Electronics, Information and Bioengineering, Politecnico, Milan, Italy; and
| | - Andrea Aliverti
- Department of Electronics, Information and Bioengineering, Politecnico, Milan, Italy; and
| | - Bruno Grassi
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Bioimaging and Molecular Physiology, National Research Council, Milan, Italy
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Validity of thoracic respiratory inductive plethysmography in high body mass index subjects. Respir Physiol Neurobiol 2017; 242:52-58. [PMID: 28363683 DOI: 10.1016/j.resp.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/22/2022]
Abstract
We aim to evaluate thoracic respiratory inductive plethysmography (RIP) in high body mass index (BMI) subjects with a pneumotachometer (PT) as a reference. We simultaneously evaluated spontaneous breathing by RIP and PT in 10 low and 10 high BMI subjects at rest and in moderate exercise. We then recorded RIP amplitude with different excursions mimicking respiratory thoracic deformation, with different sizes of RIP belts surrounding cylinders of different perimeters with or without deformable foam simulating adipose tissue. RIP responses correlated with PT values in low and high BMI groups for inspiratory time (r=0.86 and r=0.91, respectively), expiratory time (r=0.96 and r=0.91, respectively) and amplitude (r=0.82 for both) but with a bias (-0.23±0.25L) for high BMI subjects. ANOVA revealed the effects of perimeter and simulated adiposity (p<0.001 for both). We concluded that thoracic perimeter and deformity of adipose tissue are responsible for biases in RIP response in high BMI subjects.
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LoMauro A, Cesareo A, Agosti F, Tringali G, Salvadego D, Grassi B, Sartorio A, Aliverti A. Effects of a multidisciplinary body weight reduction program on static and dynamic thoraco-abdominal volumes in obese adolescents. Appl Physiol Nutr Metab 2016; 41:649-58. [PMID: 27175804 DOI: 10.1139/apnm-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objective of this study was to characterize static and dynamic thoraco-abdominal volumes in obese adolescents and to test the effects of a 3-week multidisciplinary body weight reduction program (MBWRP), entailing an energy-restricted diet, psychological and nutritional counseling, aerobic physical activity, and respiratory muscle endurance training (RMET), on these parameters. Total chest wall (VCW), pulmonary rib cage (VRC,p), abdominal rib cage (VRC,a), and abdominal (VAB) volumes were measured on 11 male adolescents (Tanner stage: 3-5; BMI standard deviation score: >2; age: 15.9 ± 1.3 years; percent body fat: 38.4%) during rest, inspiratory capacity (IC) maneuver, and incremental exercise on a cycle ergometer at baseline and after 3 weeks of MBWRP. At baseline, the progressive increase in tidal volume was achieved by an increase in end-inspiratory VCW (p < 0.05) due to increases in VRC,p and VRC,a with constant VAB. End-expiratory VCW decreased with late increasing VRC,p, dynamically hyperinflating VRC,a (p < 0.05), and progressively decreasing VAB (p < 0.05). After MBWRP, weight loss was concentrated in the abdomen and total IC decreased. During exercise, abdominal rib cage hyperinflation was delayed and associated with 15% increased performance and reduced dyspnea at high workloads (p < 0.05) without ventilatory and metabolic changes. We conclude that otherwise healthy obese adolescents adopt a thoraco-abdominal operational pattern characterized by abdominal rib cage hyperinflation as a form of lung recruitment during incremental cycle exercise. Additionally, a short period of MBWRP including RMET is associated with improved exercise performance, lung and chest wall volume recruitment, unloading of respiratory muscles, and reduced dyspnea.
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Affiliation(s)
- Antonella LoMauro
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ambra Cesareo
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Fiorenza Agosti
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Gabriella Tringali
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Desy Salvadego
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Bruno Grassi
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Alessandro Sartorio
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy.,d Division of Metabolic Diseases and Auxology, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Andrea Aliverti
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Abstract
Cardiorespiratory fitness (CRF) is one of the most important health metrics in apparently healthy individuals, those at increased risk for cardiovascular (CV) disease and virtually all patient populations. In addition to CRF, a host of other variables obtained from aerobic exercise testing provides clinically valuable information. Individuals classified as obese (i.e. a body mass index ≥30 kg/m(2)) have varying degrees of CV, pulmonary and skeletal muscle dysfunction that impact CRF and other key aerobic exercise testing variables. Moreover, there is now evidence indicating inspiratory and expiratory respiratory muscle function, even in the absence of interstitial lung disease, is potentially compromised as a result of obesity. When obesity-induced respiratory muscle dysfunction is present, it has the potential to contribute to the limitations in CRF. The current review will discuss aerobic exercise testing and the assessment of respiratory muscle function in the obese population.
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Batcho CS, Thonnard JL, Nielens H. PWC75%/kg, a Fitness Index Not Linked to Resting Heart Rate: Testing Procedure and Reference Values. Arch Phys Med Rehabil 2012; 93:1196-200. [DOI: 10.1016/j.apmr.2012.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/21/2012] [Accepted: 02/25/2012] [Indexed: 11/30/2022]
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15
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Edwards AM, Maguire GP, Graham D, Boland V, Richardson G. Four weeks of inspiratory muscle training improves self-paced walking performance in overweight and obese adults: a randomised controlled trial. J Obes 2012; 2012:918202. [PMID: 22792448 PMCID: PMC3390056 DOI: 10.1155/2012/918202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/26/2012] [Accepted: 05/10/2012] [Indexed: 12/03/2022] Open
Abstract
Objective. To examine whether a programme of inspiratory muscle training (IMT) improves accumulative distance of self-paced walking in overweight and obese adults. Methods. A total of 15 overweight and obese adults were randomized into experimental (EXP: n = 8) and placebo (PLA: n = 7) groups. Lung function, inspiratory muscle performance, 6-minute walking test, and predicted [Formula: see text]O(2) max were assessed prior to and following the 4-week IMT intervention. Both groups performed 30 inspiratory breaths, twice daily using a proprietary inspiratory resistance device set to 55% of baseline maximal effort (EXP), or performing the same inspiratory training procedure at the minimum resistive setting (PLA). Results. Lung function was unchanged in both groups after-training; however inspiratory muscle strength was significantly improved in EXP (19 ± 25.2 cm H(2)O gain; P < 0.01) but did not significantly change in PLA. Additionally, the posttraining distance covered in the 6-minute walking test was significantly extended for EXP (62.5 ± 37.7 m gain; P < 0.01), but not for PLA. A positive association was observed between the change (%) of performance gain in the 6-minute walking test and body mass index (r = 0.736; P < 0.05) for EXP. Conclusion. The present study suggests that IMT provides a practical, minimally intrusive intervention to significantly augment both inspiratory muscle performance and walking distance covered by overweight and obese adults in a clinically relevant 6-minute walk test. This indicates that IMT may provide a useful priming (preparatory) strategy prior to entry in a physical training programme for overweight and obese adults.
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Affiliation(s)
- A. M. Edwards
- Institute of Sport and Exercise Science, James Cook University, Cairns, Sydney, QLD 4870, Australia
- *A. M. Edwards:
| | - G. P. Maguire
- School of Medicine and Dentistry, James Cook University, Cairns, Sydney, QLD 4870, Australia
- Baker IDI, Research and Medical Education, Central Australia, Alice Springs, NT 0871, Australia
| | - D. Graham
- Department of Psychology, James Cook University, Cairns, QLD 4870, Australia
| | - V. Boland
- Department of Psychology, James Cook University, Cairns, QLD 4870, Australia
| | - G. Richardson
- Department of Psychology, James Cook University, Cairns, QLD 4870, Australia
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16
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Dickerson JB, Smith ML, Benden ME, Ory MG. The association of physical activity, sedentary behaviors, and body mass index classification in a cross-sectional analysis: are the effects homogenous? BMC Public Health 2011; 11:926. [PMID: 22168952 PMCID: PMC3293071 DOI: 10.1186/1471-2458-11-926] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background While much is known about the benefits of physical activity (PA) and the consequence of sedentary behaviors relative to body mass index (BMI), little is known about the homogeneity of these effects across individuals. The goal of this study was to determine if PA and sedentary behaviors have the same effect on individuals of all BMI classifications. Methods Data from a community health assessment were analyzed and a sample was selected to include respondents who self-reported a chronic disease associated with obesity (n = 2,840). Descriptive statistics were used to describe the association between selected independent variables and BMI. Simultaneous quantile regression was used to identify the degree of homogeneity in the effect of demographic independent variables, minutes per week of moderate PA, and hours per day spent watching television on BMI classification. In studies using simultaneous quantile regression, the word "effect" is used to describe association, not causation. Results Minutes per week of moderate PA had a significant effect on lower BMI, but only when respondents were at least classified as obese-class I (β = -0.001, p = 0.006). The change in effect of moderate PA in lower BMI increased significantly when respondents were classified as obese-class II versus obese-class I (F = 4.54, p = 0.033). Hours per day spent watching television had a significant effect on higher BMI, but only when the respondent was at least classified as overweight (β = 0.87, p < 0.001). The change in effect of watching television on higher BMI increased significantly when respondents were classified as obese-class I versus overweight (F = 5.57, p = 0.018). Conclusion PA and watching television were more related to BMI for obese individuals than those who were just overweight. Customized interventions for specific BMI classifications should be developed to maximize public health benefits.
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Affiliation(s)
- Justin B Dickerson
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, USA.
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Influence of physical exercise on neuroimmunological functioning and health: aging and stress. Neurotox Res 2010; 20:69-83. [PMID: 20953749 DOI: 10.1007/s12640-010-9224-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 09/16/2010] [Accepted: 09/21/2010] [Indexed: 12/20/2022]
Abstract
Chronic and acute stress, with associated pathophysiology, are implicated in a variety of disease states, with neuroimmunological dysregulation and inflammation as major hazards to health and functional sufficiency. Psychosocial stress and negative affect are linked to elevations in several inflammatory biomarkers. Immunosenescence, the deterioration of immune competence observed in the aged aspect of the life span, linked to a dramatic rise in morbidity and susceptibility to diseases with fatal outcomes, alters neuroimmunological function and is particularly marked in the neurodegenerative disorders, e.g., Parkinson's disease and diabetes. Physical exercise diminishes inflammation and elevates agents and factors involved in immunomodulatory function. Both the alleviatory effects of life-long physical activity upon multiple cancer forms and the palliative effects of physical activity for individuals afflicted by cancer offer advantages in health intervention. Chronic conditions of stress and affective dysregulation are associated with neuroimmunological insufficiency and inflammation, contributing to health risk and mortality. Physical exercise regimes have induced manifest anti-inflammatory benefits, mediated possibly by brain-derived neurotrophic factor. The epidemic proportions of metabolic disorders, obesity, and diabetes demand attention; several variants of exercise regimes have been found repeatedly to induce both prevention and improvement under both laboratory and clinical conditions. Physical exercise offers a unique non-pharmacologic intervention incorporating multiple activity regimes, e.g., endurance versus resistance exercise that may be adapted to conform to the particular demands of diagnosis, intervention and prognosis inherent to the staging of autoimmune disorders and related conditions.
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