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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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Thivel D, Ennequin G, Lambert C, Siroux J, Ratel S, Boscaro A, Pelissier L, Julian V, Cardenoux C, Duclos M, Lazzer S, Pereira B, Boirie Y, Isacco L. Improved walking energy efficiency might persist in presence of simulated full weight regain after multidisciplinary weight loss in adolescents with obesity: the POWELL study. Int J Obes (Lond) 2024; 48:384-393. [PMID: 38052874 DOI: 10.1038/s41366-023-01427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
AIM Weight loss leads to a reduction of the energy cost of walking but the respective implications of the metabolic and mechanic changes remain unknown. The present study compares the post-weight loss energy cost of walking (Cw) with and without a total reload of the induced weight reduction in adolescents with obesity. METHODS Energy cost of walking and substrate use were evaluated during a graded walking exercise (4×6-min at 0.75, 1, 1.25, 1.5 m.s-1) before (V1) and after a 12-week intervention in 21 adolescents with obesity (11 girls; 13.8 ± 1.4 y). After weight loss, the walking exercise was randomly repeated once without weight reload (V2) and once with a loading corresponding to the total induced weight loss during the program (V2L). Body composition was assessed before and after the intervention. RESULTS Body weight and fat mass decreased in response to the 12-week intervention (p < 0.001), while FFM did not change. The absolute gross Cw (ml.m-1) was higher on V1 compared with V2 at every speed. The absolute net Cw (ml.m-1) was higher on V1 compared to V2L at 0.75 m.s-1 (p = 0.04) and 1 m.s-1 (p = 0.02) and higher on V2L compared with V2 at 1.5 m.s-1 (p = 0.03). Net Cw (ml.m-1.kg-1) on V1 being higher than V2 (p < 0.001), and V2L higher than V2 (p = 0.006). The absolute CHO oxidation (mg.min-1) did not show any condition effect (p = 0.12) while fat utilization was higher on V1 compared to V2 and V2L (p < 0.001). Relative to body weight CHO oxidation was lower on V1 compared to V2 (p = 0.04) and V2L (p = 0.004) while relative to body weight fat oxidation was higher on V1 than V2 (p = 0.002). CONCLUSION Adolescents with obesity might not show an entire rise back to pre-weight loss values of their metabolic cost of walking when weight gain is simulated. These new findings suggest metabolic and physiological adaptations to weight loss of the energy metabolism that remain to be clarified.
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Affiliation(s)
- D Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France.
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, 63000, Clermont-Ferrand, France.
| | - G Ennequin
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, 63000, Clermont-Ferrand, France
| | - C Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - J Siroux
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - S Ratel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - A Boscaro
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - L Pelissier
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - V Julian
- CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Sport Medicine and Functional and Respiratory Rehabilitation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - C Cardenoux
- Children Medical Center, 63450, Romagnat, France
| | - M Duclos
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, 63000, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Sport Medicine and Functional and Respiratory Rehabilitation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - S Lazzer
- Department of Medicine, School of Sport Sciences, University of Udine, 33058, Udine, Italy
| | - B Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Y Boirie
- CSO-CALORIS, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Department of Human Nutrition, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - L Isacco
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, 63000, Clermont-Ferrand, France
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, 63000, Clermont-Ferrand, France
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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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Xu R, Huang QT, Chen YT, Wang PY. Effects and dose-response relationships of exercise intervention on weight loss in overweight and obese children: a meta-regression and system review. J Pediatr Endocrinol Metab 2022; 35:1117-1131. [PMID: 35933324 DOI: 10.1515/jpem-2022-0209] [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] [Received: 04/14/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Rui Xu
- School of Sports and Health, Nanjing Sport Institute, Nanjing, P.R. China.,Laboratory of Kinesiology, Nanjing Sport Institute, Nanjing, P.R. China
| | - Qiao-Ting Huang
- College of Physical Education, Chengdu University, Chengdu, P.R. China
| | - Yu-Ting Chen
- School of Sports and Health, Nanjing Sport Institute, Nanjing, P.R. China
| | - Peng-Yin Wang
- School of Sports and Health, Nanjing Sport Institute, Nanjing, P.R. China
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Lemos MM, Cavalini GR, Pugliese Henrique CR, Perli VAS, de Moraes Marchiori G, Marchiori LLDM, Sordi AF, Franzói de Moraes SM, de Paula Ramos S, Valdés-Badilla P, Mota J, Magnani Branco BH. Body composition and cardiorespiratory fitness in overweight or obese people post COVID-19: A comparative study. Front Physiol 2022; 13:949351. [PMID: 36213222 PMCID: PMC9532828 DOI: 10.3389/fphys.2022.949351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
The present study aimed to evaluate the body composition and cardiorespiratory fitness of overweight or obese people after COVID-19. 171 volunteers of both sexes (men, n = 93 and women, n = 78) between 19 and 65 years old were allocated into three groups according to the severity of their symptoms of COVID-19: non-hospitalized people/mild symptoms (n = 61), hospitalized (n = 58), and hospitalized in an intensive care unit-ICU (n = 52). Two laboratory visits were carried out 24 h apart. First, a medical consultation was carried out, with subsequent measurement of body weight and height (calculation of body mass index) and body composition assessment via electrical bioimpedance. After 24 h, a cardiorespiratory test was performed using the Bruce protocol, with a direct gas exchange analysis. Hospitalized individuals had significantly higher values for fat mass and body fat percentage than non-hospitalized individuals (p < 0.05). Significantly higher values were found for heart rate (HR) and peak oxygen consumption (VO2peak) for individuals who were not hospitalized when compared to those hospitalized in the ICU (p < 0.05). Significantly higher values for distance, ventilation, and the relationship between respiratory quotient were found for non-hospitalized individuals compared to hospitalized individuals and those in the ICU (p < 0.05). After the cardiorespiratory test, higher values for peripheral oxygen saturation (SpO2) were observed for non-hospitalized individuals than for all hospitalized individuals (p < 0.05). Diastolic blood pressure was significantly higher at the tenth and fifteenth minute post-Bruce test in hospitalized than in non-hospitalized participants (p < 0.05). Based on these results, proposals for cardiopulmonary rehabilitation are indispensable for hospitalized groups considering the responses of blood pressure. Monitoring HR, SpO2, and blood pressure are necessary during rehabilitation to avoid possible physical complications. Volume and intensity of exercise prescription should respect the physiologic adaptation. Given lower physical conditioning among all the groups, proposals for recovering from health conditions are urgent and indispensable for COVID-19 survivors.
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Affiliation(s)
- Maurício Medeiros Lemos
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
- Postgraduate Program in Health Promotion, Cesumar University, Paraná, Brazil
| | - Gustavo Rocha Cavalini
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
- Medicine Course, Department of Health Sciences, Cesumar University, Maringá, Brazil
| | - Carlos Renato Pugliese Henrique
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
- Medicine Course, Department of Health Sciences, Cesumar University, Maringá, Brazil
| | - Victor Augusto Santos Perli
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
- Medicine Course, Department of Health Sciences, Cesumar University, Maringá, Brazil
| | | | | | - Ana Flávia Sordi
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
| | | | | | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar, Chile
| | - Jorge Mota
- Research Centre of Physical Activity, Health and Leisure, Faculty of Sports; Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Braulio Henrique Magnani Branco
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Maringá, Brazil
- Postgraduate Program in Health Promotion, Cesumar University, Paraná, Brazil
- Medicine Course, Department of Health Sciences, Cesumar University, Maringá, Brazil
- Research Centre of Physical Activity, Health and Leisure, Faculty of Sports; Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Physiology and Nutrition Department, Clinisport Prime, Maringa, Brazil
- *Correspondence: Braulio Henrique Magnani Branco,
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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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D'Alleva M, Gonnelli F, Vaccari F, Boirie Y, Montaurier C, Thivel D, Isacco L, Vermorel M, Lazzer S. Energy cost of walking and body composition changes during a 9-month multidisciplinary weight reduction program and 4-month follow-up in adolescents with obesity. Appl Physiol Nutr Metab 2021; 47:1-9. [PMID: 34516928 DOI: 10.1139/apnm-2021-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of the present study was to investigate changes in the energy cost of locomotion during walking (Cw) related to changes in body mass (BM, kg) and body composition in adolescents with obesity. Twenty-six (12 boys and 14 girls) obese adolescents (mean: body mass index, 33.6 ± 3.7 kg·m-2; 42.7 ± 4.5% fat mass (FM)) followed a 9-month multidisciplinary inpatient weight-reduction program consisting of lifestyle education, moderate energy restriction, and regular physical activity in a specialised institution. At baseline (M0), the end of the 9-month program (M9), and after the 4-month follow-up (M13), oxygen consumption and carbon dioxide production of the standardised activity program were assessed by whole-body indirect calorimetry over 24 hours, and body composition was assessed by dual-energy X-ray absorptiometry. At M9, adolescents showed an 18% reduction in BM (p < 0.001) and 40% in total FM, while fat-free mass (kg) remained stable in boys but decreased by ∼6% in girls (p = 0.001). Similarly, the mean Cw decreased by 20% (p < 0.001). At M13, BM, FM, and Cw were slightly higher compared with at M9. In conclusion, moderate energy restriction and regular moderate physical activities improved walking economy, improved exercise tolerance, and induced beneficial changes in the body composition of adolescents with obesity. Novelty: Reduction of FM in the trunk region, and consequently reducing the work carried out by respiratory muscles, contributes to reducing Cw in adolescents with obesity. A lower walking cost can be effective in improving exercise tolerance and quality of life in obese adolescents.
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Affiliation(s)
- Mattia D'Alleva
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Filippo Vaccari
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Yves Boirie
- CHU Clermont-Ferrand, Department of Clinical Nutrition, Clermont-Ferrand, France
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Christophe Montaurier
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, CRNH Auvergne, Clermont-Ferrand, France
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laurie Isacco
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, CRNH Auvergne, Clermont-Ferrand, France
| | - Michel Vermorel
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
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Zuccarelli L, Sartorio A, DE Micheli R, Tringali G, Grassi B. Obese Patients Decrease Work Rate in Order to Keep a Constant Target Heart Rate. Med Sci Sports Exerc 2021; 53:986-993. [PMID: 33148969 DOI: 10.1249/mss.0000000000002551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE "Slow components" of heart rate (HR) kinetics, occurring also during moderate-intensity constant work rate exercise, represent a problem for exercise prescription at fixed HR values. This problem, described in young healthy subjects, could be more pronounced in obese patients. METHODS Sixteen male obese patients (age, 22 ± 7 yr; body mass, 127 ± 19 kg; body mass index, 41.6 ± 3.9 kg·m-2) were tested before (PRE) and after (POST) a 3-wk multidisciplinary body mass reduction program, entailing moderate-intensity exercise. They performed on a cycle ergometer an incremental exercise to voluntary exhaustion (to determine peak pulmonary oxygen uptake (V˙O2peak) and gas exchange threshold (GET)) and constant work rate exercises: moderate-intensity (MODERATE; 80% of GET determined in PRE), heavy-intensity (HEAVY; 120% of GET determined in PRE), and "HRCLAMPED" exercise, in which work rate was continuously adjusted to maintain a constant HR corresponding to that at 120% of GET. Breath-by-breath V˙O2 and HR were determined. RESULTS V˙O2peak and GET (expressed as a percent of V˙O2peak) were not significantly different in PRE versus POST. In POST versus PRE, the HR slow component disappeared (MODERATE) or was reduced (HEAVY). In PRE, work rate had to decrease by ~20% over a 15-min task in order to keep HR constant; this decrease was significantly smaller (~5%) in POST. CONCLUSIONS In obese patients, a 3-wk multidisciplinary body mass reduction intervention i) increased exercise tolerance by eliminating (during MODERATE) or by reducing (during HEAVY) the slow component of HR kinetics, and ii) facilitated exercise prescription by allowing to translate a fixed submaximal HR value into a work rate slightly above GET.
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Affiliation(s)
| | | | - Roberta DE Micheli
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), ITALY
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), ITALY
| | - Bruno Grassi
- Department of Medicine, University of Udine, Udine, ITALY
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Acute respiratory muscle unloading improves time-to-exhaustion during moderate- and heavy-intensity cycling in obese adolescent males. Sci Rep 2020; 10:17036. [PMID: 33046823 PMCID: PMC7550339 DOI: 10.1038/s41598-020-74240-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/23/2020] [Indexed: 11/08/2022] Open
Abstract
Obesity significantly impairs breathing during exercise. The aim was to determine, in male obese adolescents (OB), the effects of acute respiratory muscle unloading, obtained by switching the inspired gas from ambient air (AIR) to a normoxic helium + oxygen gas mixture (HeO2) (AIR → HeO2) during moderate [below gas exchange threshold (GET)] and heavy [above GET] constant work rate cycling. Ten OB [age 16.0 ± 2.0 years (mean ± SD); body mass index (BMI) 38.9 ± 6.1 kg/m2] and ten normal-weight age-matched controls (CTRL) inspired AIR for the entire exercise task, or underwent AIR → HeO2 when they were approaching volitional exhaustion. In OB time to exhaustion (TTE) significantly increased in AIR → HeO2 vs. AIR during moderate [1524 ± 480 s vs. 1308 ± 408 (P = 0.024)] and during heavy [570 ± 306 s vs. 408 ± 150 (P = 0.0154)] exercise. During moderate exercise all CTRL completed the 40-min task. During heavy exercise no significant differences were observed in CTRL for TTE (582 ± 348 s [AIR → HeO2] vs. 588 ± 252 [AIR]). In OB, but not in CTRL, acute unloading of respiratory muscles increased TTE during both moderate- and heavy-exercise. In OB, but not in CTRL, respiratory factors limit exercise tolerance during both moderate and heavy exercise.
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Sheel AW, Dominelli PB. Breathing during exercise: There is no such thing as a free lunch. Exp Physiol 2019; 104:1333-1334. [PMID: 31325338 DOI: 10.1113/ep087922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Vaccari F, Floreani M, Tringali G, De Micheli R, Sartorio A, Lazzer S. Metabolic and muscular factors limiting aerobic exercise in obese subjects. Eur J Appl Physiol 2019; 119:1779-1788. [PMID: 31187280 DOI: 10.1007/s00421-019-04167-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the present study was to understand the role of central (cardiovascular O2 delivery) and peripheral factors (muscle level) in limiting the maximal aerobic performance in obese (OB) subjects. METHODS Fifteen OB (mean age ± SD 25 ± 7 years; BMI 43 ± 7 kg/m2) and 13 lean sedentary subjects (CTRL, age 27 ± 7 years; BMI 22 ± 3 kg/m2) participated in this study. Oxygen uptake (VO2), hearth rate (HR) and cardiac output (CO) were measured during cycle ergometer (CE) and knee extension (KE) incremental tests. Maximal voluntary contractions (MVCs) of knee extensor muscles were performed before and immediately after the two tests. RESULTS VO2peak, HR peak and CO peak were significantly higher in CE than KE (+ 126%, + 33% and + 46%, respectively, p < 0.001), both in OB and CTRL subjects, without differences between the two subgroups. Maximal work rate was lower in OB than CTRL (191 ± 38 vs 226 ± 39 W, p < 0.05) in CE, while it was similar between the two subgroups in KE. Although CE and KE determined a reduction of MVC in both subgroups, MVC resulted less decreased after CE than KE exercises (- 14 vs - 32%, p < 0.001) in OB, while MVC decrements were similar after the two exercises in CTRL (- 26% vs - 30%, p > 0.05, for CE and KE, respectively). CONCLUSIONS The lower muscle fatigue observed in OB after CE compared to KE test suggests that central factors could be the most important limiting factor during cycling in OB.
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Affiliation(s)
- Filippo Vaccari
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy. .,School of Sport Sciences, University of Udine, Udine, Italy.
| | - Mirco Floreani
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Roberta De Micheli
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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