Use of Physical Activity and Exercise to Reduce Inflammation in Children and Adolescents with Obesity

Does autonomous motivation and self-efficacy mediate associations between environmental factors and physical activity in adolescents?

BACKGROUND

To analyze the associations among autonomous motivation, self-efficacy, satisfaction of basic psychological needs, social support and perceived environment with physical activity practice of adolescents aged between 12 and 15 years; and to test autonomous motivations and self-efficacy as potential mediators of the associations between these environmental factors and physical activity practice.

METHODS

We evaluated 553 adolescents, that participated in the ActTeens Program. Physical activity was assessed using the Physical Activity Questionnaire for Adolescents. Autonomous motivation, self-efficacy, satisfaction of basic psychological needs, parents' social support and perceived environment were assessed using specifics questionnaires. Linear regression models were used to test the associations.

RESULTS

Parents' support (β = 0.32), satisfaction of basic psychological needs of colleagues (β = 0.21) and teachers (β = 0.12), and perceived environment (β = 0.10) had significant associations with physical activity (p < 0.05). The direct effect value was reduced when autonomous motivation was added as a mediator of the association between parents' support and physical activity (β = 0.24), with a 25% mediated effect. Autonomous motivation was mediator of the relationship between basic psychological needs of colleagues (β = 0.13; EM = 38%), teachers (β = 0.02; EM = 83%), and perceived environment (β = 0.03; EM = 70%) with physical activity.

CONCLUSION

Self-efficacy was not associated with physical activity and autonomous motivation was an important mediator of adolescents' physical activity.

Cardiorespiratory Fitness Is an Indicator of Arterial Stiffness and Aortic Blood Pressure in Healthy Adolescents

Background/Objectives: We aimed to investigate the influence of cardiorespiratory fitness (CRF) and body composition on arterial stiffness. Methods: Carotid-to-femoral pulse wave velocity (cfPWV) and aortic systolic (ASBP) and diastolic (ADBP) blood pressure were compared between upper and lower tertiles of oxygen consumption at the aerobic threshold (VO2AerT), peak oxygen consumption (VO2peak), percentage of fat mass (FM%), and body mass index (BMI) in sixty adolescents (30 males and 30 females, 14.9 ± 2.1 years old). A stepwise multivariable linear regression analysis was performed to investigate the independent associations between VO2AerT and VO2peak and cfPWV, and between BMI and FM% and cfPWV with adjustments for age, sex, ASBP, and ADBP. Results: cfPWV and ADBP were lower in the second and third VO2AerT tertiles compared to the first tertile (cfPWV, 4.7 ± 0.5 and 4.7 ± 0.5 vs. 5.3 ± 0.8 m/s, p < 0.01; ADBP, 62 ± 7 and 62 ± 7 vs. 70 ± 8 mmHg, p < 0.01). ASBP was lower in the third VO2AerT tertile compared to the first tertile (94 ± 7 vs. 101 ± 12 mmHg, p = 0.05). ADBP was lower in the second VO2peak tertile compared to the first tertile (62 ± 7 vs. 68 ± 9 mmHg, p = 0.03). ASBP was lower in the first and second BMI tertiles compared to the third tertile (95 ± 8 and 95 ± 7 vs. 102 ± 11 mmHg, p = 0.02). The eight-variable model significantly contributed to the variance of cfPWV (F(8, 51) = 7.450, p < 0.01), accounting for 47% of the variance. Individually, age (p < 0.05) and ADBP (p < 0.01) significantly predicted cfPWV. Conclusions: Submaximal indicators of CRF such as VO2AerT should be considered as a part of the risk stratification of cardiovascular disease in healthy adolescents.

Effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory in overweight and obese individuals: A systematic review

This systematic review aimed to establish the effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory (WM) in individuals living with overweight and obesity. A comprehensive literature search was conducted using the Scopus, PubMed, Springer-Link, RefSeek, and Cochrane Library databases to identify relevant publications up to January 18, 2024. Data on participants' characteristics, intervention settings, and key outcomes related to WM were extracted. The quality of the studies was assessed using the PEDro scale. A total of 15 articles met pre-established inclusion criteria, involving participants across nine countries with a range of 12-125 individuals and ages spanning from 6 to 80 years old. Among the studies analyzed, 10 exclusively investigated exercise interventions, whereas five explored the combined effects. Notably, 70% of the exercise interventions (7 out of 10) exhibited positive improvements in WM. Likewise, 60% of the combined interventions (3 out of 5) demonstrated favorable enhancements in WM. No differences were found between the two protocols. Common features between the protocols were identified and described. Both protocols showed favorable and promising effects on WM in this clinical population. Nonetheless, the limited evidence addressing the combination of exercise and diet in the same research approach reduces the generalizability of the findings. This review offers valuable insights for future clinical and research applications in people with overweight and obesity.

The Effects of Exercise Interventions on Ectopic and Subcutaneous Fat in Patients with Type 2 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Meta-Regression

Background/Objectives: The aim of the present study was to determine the effects of exercise training on ectopic and subcutaneous fat in patients with type 2 diabetes mellitus (T2DM). Methods: Web of Science, PubMed, and Scopus were searched for original articles published through November 2023 that included exercise versus control interventions on body mass (BM), liver fat percentage, visceral fat area (VFA), subcutaneous fat area (SFA), and intramuscular fat volume or mass (IMF) in patients with T2DM. Weighted mean differences (WMDs) for liver fat and BM, standardized mean differences (SMDs) for VFA, SFA, and IMF, and 95% confidence intervals (95% CIs) were determined using random-effects models. Results: Thirty-six studies comprising 2110 patients with T2DM were included in the present meta-analysis. Exercise training effectively reduced BM [WMD = -2.502 kg, p = 0.001], liver fat% [WMD = -1.559%, p = 0.030], VFA [SMD = -0.510, p = 0.001], and SFA [SMD = -0.413, p = 0.001] in comparison to the control. The IMF [SMD = 0.222, p = 0.118] remained unchanged compared to the controls. Subgroup analyses showed that the type of exercise, duration, and body mass index (BMI) of participants were sources of heterogeneity. Conclusions: The current meta-analysis provides strong evidence that exercise training, particularly aerobic and combined (aerobic and resistance) exercise programs, is effective for reducing BM, VFA, and SFA in patients with T2DM. However, aerobic exercise was more effective for reducing liver fat than combined exercise. The beneficial effects of exercise on VFA and SFA reduction, but not liver fat, are associated with weight loss. These findings highlight the importance of including consistent exercise as a key management component for T2DM and associated ectopic fat deposition, with potential long-term benefits for metabolic health.

METS-IR/HOMA-IR and MAFLD in U.S. adults: dose-response correlation and the effect mediated by physical activity

OBJECTIVES

Metabolic dysfunction-associated fatty liver disease (MAFLD), a globally prevalent disease, is closely linked to insulin resistance (IR). Physical activity (PA) is closely linked to both MAFLD and IR. We aim to explore the dose-response relationship between metabolic score for IR (METS-IR)/homeostasis model assessment of IR (HOMA-IR) and MAFLD, and investigate the relationship between PA, IR and MAFLD.

METHODS

Participants from the NHANES study were included in this cross-section study. Logistic regression and the receiver operating characteristic were used to assess the predictive performance of METS-IR/HOMA-IR for MAFLD. Restrictive cubic splines were performed to visualize their dose-response relationship. Decision tree analysis was used to identify high-risk populations of MAFLD. PA's mediating effect in the association between METS-IR/HOMA-IR and MAFLD was also examined.

RESULTS

Of all 1,313 participants, 693 had MAFLD (52.78%). There were a positive association between METS-IR (OR = 1.162, 95% CI = 1.126-1.199) and HOMA-IR (OR = 1.630, 95% CI = 1.431-1.856) and MAFLD risk. The AUCs of the METS-IR and HOMA-IR were 0.831 (0.809, 0.853) and 0.767 (0.741, 0.791), respectively, with significantly different predictive performance (P < 0.001). Adding METS-IR/HOMA-IR to the basic model greatly improved the statistical significance for MAFLD. Five high-risk subgroups were identified for MAFLD. PA mediated about 0.81% and 0.78% (indirect effect/total effect) in the association between METS-IR/HOMA-IR and MAFLD.

CONCLUSIONS

MAFLD risk might be predicted by METS-IR/HOMA-IR, among which METS-IR performed better. And PA mediated the association between them. More attention should be paid to the therapeutic effect of lifestyle changes on MAFLD.

HIGHLIGHTS

1. Positive associations were found between METS-IR and HOMA-IR and MAFLD risk. 2. METS-IR has better predictive performance for MAFLD risk than HOMA-IR. 3.Two high-risk subgroups were identified for MAFLD by METS-IR: individuals with METS-IR ≥ 40; Hispanic black individuals with 34 ≤ METS-IR < 40 and aged ≥ 46. 4. In the significant association between METS-IR/HOMA-IR and MAFLD, about 0.81% and 0.78% (indirect effect/total effect), respectively, were mediated by physical activity.

Effects of a 217-km mountain ultramarathon on the gut microbiota of an obese runner: A case report

Obesity is characterized by specific changes in the composition of the gut microbiota (GM). Exercise can contribute to the modulation of GM. This is the first case study to analyze the composition and metabolism of the GM of an obese runner in a single-stage mountain ultramarathon (MUM) with a mileage of 217 km. Fecal samples were collected 7 days before the race (T0), 15 min after the end of the race (T1), and 7 days after the end of the race (T2). GM composition was analyzed by real-time PCR and shotgun sequencing. We observed a decrease in Bacillota/Bacteroidota ratio and α-diversity after the race. After the 217-km MUM, we observed a decrease in symbiont microorganisms and a notable increase in harmful bacteria. In conclusion, we found that the 217-km MUM may have contributed to the intestinal dysbiosis of the obese runner.

Assessing the impact of concurrent high-fructose and high-saturated fat diets on pediatric metabolic syndrome: A review

High-saturated fat (HF) or high-fructose (HFr) consumption in children predispose them to metabolic syndrome (MetS). In rodent models of MetS, diets containing individually HF or HFr lead to a variable degree of MetS. Nevertheless, simultaneous intake of HF plus HFr have synergistic effects, worsening MetS outcomes. In children, the effects of HF or HFr intake usually have been addressed individually. Therefore, we have reviewed the outcomes of HF or HFr diets in children, and we compare them with the effects reported in rodents. In humans, HFr intake causes increased lipogenesis, hypertriglyceridemia, obesity and insulin resistance. On the other hand, HF diets promote low grade-inflammation, obesity, insulin resistance. Despite the deleterious effects of simultaneous HF plus HFr intake on MetS development in rodents, there is little information about the combined effects of HF plus HFr intake in children. The aim of this review is to warn about this issue, as individually addressing the effects produced by HF or HFr may underestimate the severity of the outcomes of Western diet intake in the pediatric population. We consider that this is an alarming issue that needs to be assessed, as the simultaneous intake of HF plus HFr is common on fast food menus.

Obesity and Preventive Intervention Among Children: A Narrative Review

Childhood obesity has become a major public health concern around the world, with a rise in prevalence over the last few decades. This abstract provides an overview of pediatric obesity, including its causes, implications, and potential treatments. Childhood obesity is caused by a complex combination of environmental, genetic, and behavioral variables. A child's likelihood of developing obesity is influenced by factors, such as socioeconomic status, family dynamics, and cultural norms. Childhood obesity leads to extensive repercussions, elevating the risk of chronic conditions, such as diabetes, cardiovascular diseases, and mental health challenges. Furthermore, children dealing with obesity often face social stigmatization, diminished self-esteem, and academic struggles. Efforts to prevent and manage childhood obesity should employ a comprehensive and multi-tiered approach. This involves enacting policies geared toward enhancing nutrition in schools and communities, advocating for increased physical activity (PA), and curbing sedentary behaviors.

Poor Motor Competence Affects Functional Capacities and Healthcare in Children and Adolescents with Obesity

BACKGROUND

From a young age, children learn different motor skills known as fundamental motor skills. The acquisition of these skills is crucial for the future development of context-tailored actions that could improve adherence to physical activity (PA) practice. Motor competence and function deficits have been associated with pediatric obesity. We reviewed the literature data regarding motor competence in pediatrics and impaired motor performance in children and adolescents with obesity.

METHODS

We assessed the abstracts of the available literature (n = 110) and reviewed the full texts of potentially relevant articles (n = 65) that were analyzed to provide a critical discussion.

RESULTS

Children and adolescents with obesity show impaired motor performance, executive functions, postural control, and motor coordination. Children's age represents a crucial point in the development of motor skills. Early interventions are crucial to preventing declines in motor proficiency and impacting children's PA and overall fitness levels.

CONCLUSIONS

To involve children, the PA protocol must be fun and tailored in consideration of several aspects, such as clinical picture, level of physical fitness, and motor skills. A supervised adapted exercise program is useful to personalized PA programs from an early pediatric age.

The complex associations between adiposity, fitness, mental wellbeing and neurocognitive function after exercise: A randomized crossover trial in preadolescent children

The aim of the present study was to examine the associations of adiposity and fitness on the preadolescent brain's response to acute exercise. In a sample of 58 children (ages 8-10; 19 females), demographic measures of age, sex, IQ, puberty, and socioeconomic status were considered. Children participated in a randomized crossover study, whereby they completed two different interventions; seated rest or treadmill walking, counterbalanced across participants. Associations between adiposity measures (standardized body mass index [BMI-Z], whole body percent fat [%Fat], visceral adipose tissue [VAT]), cardiorespiratory fitness measures (VO2max and Fat-Free VO2) were assessed on self-reported measures of mental wellbeing, and cognitive performance (response accuracy, reaction time) and neuroelectric (P3 amplitude and latency) indices of a Go/NoGo task following both exercise and rest interventions. Higher adiposity (whole-body percent fat, BMI-Z) was associated with higher trait anxiety (P's≤0.05) and disordered eating (P's≤0.05) scores. Higher fitness (VO2max) was associated with lower childhood depression scores (P=0.02). Regression analyses yielded specific post-exercise neurocognitive associations with adiposity-related (VAT, BMI-Z), and fitness-related (FF-VO2) outcomes, after controlling for post-rest neurocognitive outcomes. VAT was positively associated with post-exercise P3 ERP Latency for the Go task (P≤0.001); BMI-Z was negatively associated with P3 ERP amplitudes for the Go task (P's≤0.005); FF-VO2 was negatively associated with P3 ERP latency for the Go/NoGo task (P's≤0.05), and positively associated with NoGo task accuracy (P≤0.001). Overall, adiposity and fat-free fitness measures yield sensitive and differential associations with neurocognitive performance after exercise and after rest interventions.

Effect of a Supervised Exercise Program on Overweight and Obese Adolescents in the School Environment: A Pretest-Posttest Design

This study is taken up to evaluate the effect of an exercise program on adolescents' obesity and overweight profile. For this purpose, a 1-group pretest-posttest study was conducted with 72 adolescents who underwent a physical activity program supervised by one health professional 5 times a week; the sessions were distributed over 12 weeks and lasted from 50 to 60 minutes. The primary outcomes were anthropometric measurements, whereas the secondary outcomes were lipid profile, blood glucose, and blood pressure. Outcomes were assessed before the intervention and 1 day after the program ended; significance was established at P < .05. As a result, a significant improvement was verified in all the primary outcomes (P< .001) and in most secondary outcomes (capillary blood glucose, P = .0001; triglycerides, P = .0001; and systolic blood pressure, P = .005). In conclusion, the supervised exercise program significantly reduced anthropometric measurements and blood glucose, triglycerides, and systolic blood pressure levels.

The role of IGF-1 in exercise to improve obesity-related cognitive dysfunction

Obesity is an important factor that threatens human health. The occurrence of many chronic diseases is related to obesity, and cognitive function decline often occurs with the onset of obesity. With the further prevalence of obesity, it is bound to lead to a wider range of cognitive dysfunction (ORCD). Therefore, it is crucial to suppress ORCD through intervention. In this regard, exercise has been shown to be effective in preventing obesity and improving cognitive function as a non-drug treatment. There is sufficient evidence that exercise has a regulatory effect on a growth factor closely related to cognitive function-insulin-like growth factor 1 (IGF-1). IGF-1 may be an important mediator in improving ORCD through exercise. This article reviews the effects of obesity and IGF-1 on cognitive function and the regulation of exercise on IGF-1. It analyzes the mechanism by which exercise can improve ORCD by regulating IGF-1. Overall, this review provides evidence from relevant animal studies and human studies, showing that exercise plays a role in improving ORCD. It emphasizes the importance of IGF-1, which helps to understand the health effects of exercise and promotes research on the treatment of ORCD.

Exploring the Heart-Mind Connection: Unraveling the Shared Pathways between Depression and Cardiovascular Diseases

Civilization diseases are defined as non-communicable diseases that affect a large part of the population. Examples of such diseases are depression and cardiovascular disease. Importantly, the World Health Organization warns against an increase in both of these. This narrative review aims to summarize the available information on measurable risk factors for CVD and depression based on the existing literature. The paper reviews the epidemiology and main risk factors for the coexistence of depression and cardiovascular disease. The authors emphasize that there is evidence of a link between depression and cardiovascular disease. Here, we highlight common risk factors for depression and cardiovascular disease, including obesity, diabetes, and physical inactivity, as well as the importance of the prevention and treatment of CVD in preventing depression and other mental disorders. Conversely, effective treatment of CVD can also help prevent depression and improve mental health outcomes. It seems advisable to introduce screening tests for depression in patients treated for cardiac reasons. Importantly, in patients treated for mood disorders, it is worth controlling CVD risk factors, for example, by checking blood pressure and pulse during routine visits. It is also worth paying attention to the mental condition of patients with CVD. This study underlines the importance of interdisciplinary co-operation.

The effects of physical exercise therapy on weight control: its regulation of adipocyte physiology and metabolic capacity

Factors associated with increased body mass, including dyslipidemia, hypertension, insulin resistance, vascular endothelial dysfunction and sleep disorders, may contribute to the exacerbation of cardiovascular disease. These health problems associated with obesity are caused by accumulated metabolism and physical and emotional stress. Lifestyle, especially exercise, is a major therapeutic strategy for the treatment and management of obesity-induced metabolic problems. Metabolic disease often co-occurs with abdominal obesity. Exercise is necessary for the treatment of obesity, diabetes and cardiovascular disease. A potential benefit of exercise is to promote fat burning and energy use increases both during exercise itself and in the post-exercise period. Exercise suppresses basal metabolic rate and also has many health benefits. Why should we exercise to lose weight? Does physical activity help lower blood pressure, blood cholesterol, and blood sugar? In this article, we review the positive effects of physical exercise on weight maintenance and weight loss, and the effectiveness of physical exercise on the treatment and prevention of metabolic syndrome.

Impact of COVID-19 on Physical Activity in Families Managing ADHD and the Cyclical Effect on Worsening Mental Health

Physical activity supports symptom management in children with ADHD and reduces the mental health burden associated with caregiving for children with ADHD. Survey-based research shows that COVID-19 reduced physical activity among diverse populations. This study used a qualitative approach situated within a socioecological framework to (1) understand how COVID-19 impacted physical activity of children with ADHD and their caregivers, to (2) identify barriers to their physical activity, and to (3) identify potential areas of support. Thirty-three participants were interviewed between October 2020 and January 2021. Content analysis revealed that physical activity declined for children and caregivers; significant barriers were social isolation and rising intrapersonal difficulties such as diminishing self-efficacy and energy levels and increased mental health difficulties. Worsening mental health further alienated caregivers and children from physical activity, undermining its protective effects on ADHD symptom management and mental wellbeing. Participants identified needing community support programs that offer virtual, live physical activity classes as well as psycho-emotional support groups. There is vital need to support physical activity opportunities during high-stress situations in families managing ADHD to buffer against diminishing mental wellbeing. This will promote further physical activity engagement and allow families to reap the cognitive, psychological, and emotional benefits.

Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity

Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children's poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.

The Preventive Effect of Exercise and Oral Branched-Chain Amino Acid Supplementation on Obesity-Induced Brain Changes in Ldlr−/−.Leiden Mice

Exercise and dietary interventions are promising approaches to tackle obesity and its obesogenic effects on the brain. We investigated the impact of exercise and possible synergistic effects of exercise and branched-chain amino acids (BCAA) supplementation on the brain and behavior in high-fat-diet (HFD)-induced obese Ldlr−/−.Leiden mice. Baseline measurements were performed in chow-fed Ldlr−/−.Leiden mice to assess metabolic risk factors, cognition, and brain structure using magnetic resonance imaging. Thereafter, a subgroup was sacrificed, serving as a healthy reference. The remaining mice were fed an HFD and divided into three groups: (i) no exercise, (ii) exercise, or (iii) exercise and dietary BCAA. Mice were followed for 6 months and aforementioned tests were repeated. We found that exercise alone changed cerebral blood flow, attenuated white matter loss, and reduced neuroinflammation compared to non-exercising HFD-fed mice. Contrarily, no favorable effects of exercise on the brain were found in combination with BCAA, and neuroinflammation was increased. However, cognition was slightly improved in exercising mice on BCAA. Moreover, BCAA and exercise increased the percentage of epididymal white adipose tissue and muscle weight, decreased body weight and fasting insulin levels, improved the circadian rhythm, and transiently improved grip strength. In conclusion, BCAA should be supplemented with caution, although beneficial effects on metabolism, behavior, and cognition were observed.

COVID-19: Insights into long-term manifestations and lockdown impacts

Coronaviruses are pathogens thought to primarily affect the respiratory tracts of humans. The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 was also marked mainly by its symptoms of respiratory illness, which were named coronavirus disease 2019 (COVID-19). Since its initial discovery, many other symptoms have been linked to acute SARS-CoV-2 infections as well as to the long-term outcomes of COVID-19 patients. Among these symptoms are different categories of cardiovascular diseases (CVDs), which continue to be the main cause of death worldwide. The World Health Organization estimates that 17.9 million people die from CVDs each year, accounting for ∼32% of all deaths globally. Physical inactivity is one of the most important behavioral risk factors for CVDs. The COVID-19 pandemic has affected CVDs as well as the physical activity in different ways. Here, we provide an overview of the current status as well as future challenges and possible solutions.

Effects of Endurance Exercise Intensities on Autonomic and Metabolic Controls in Children with Obesity: A Feasibility Study Employing Online Exercise Training

Exercise is one of the major determinants of a healthy lifestyle, which is particularly important in childhood and serves as a powerful preventive tool. On the other hand, obesity and arterial hypertension rates are increasing in children, representing a huge risk for developing major cardiovascular and metabolic diseases in adult life. Of fundamental importance is the modality and volume of exercise required to obtain benefits. In this feasibility study, we considered a group of obese children, studied before and after a 12-week online exercise training program, and subdivided the participants into two groups considering the volume of exercise performed (above or below 1200 MET·min/week). This threshold level was applied in two different ways: subdivision A considered the total weekly physical activity volume (considering both time spent walking for at least 10 min consecutively and time spent performing structured exercise) and subdivision B considered only the weekly volume of structured exercise. We assessed autonomic and metabolic control and auxological and lifestyle parameters. We observed that the improved volume of structured exercise was associated with reduced arterial pressure percentile only in subdivision B and an improvement in markers of vagal and metabolic control was evident. Moreover, the 12-week online exercise training program, defined considering individual fitness level and progressively adapted as the goal was reached, proved to be sustainable from an economical and organizational point of view.

Influence of routine exercise on the peripheral immune system to prevent and alleviate pain

Routine physical activity reduces the onset of pain and exercise is a first line treatment for individuals who develop chronic pain. In both preclinical and clinical research regular exercise (routine exercise sessions) produces pain relief through multiple mechanisms such as alterations in the central and peripheral nervous system. More recently, it has been appreciated that exercise can also alter the peripheral immune system to prevent or reduce pain. In animal models, exercise can alter the immune system at the site of injury or pain model induction, in the dorsal root ganglia, and systemically throughout the body to produce analgesia. Most notably exercise shows the ability to dampen the presence of pro-inflammatory immune cells and cytokines at these locations. Exercise decreases M1 macrophages and the cytokines IL-6, IL-1β, and TFNα, while increasing M2 macrophages and the cytokines IL-10, IL-4, and IL-1ra. In clinical research, a single bout of exercise produces an acute inflammatory response, however repeated training can lead to an anti-inflammatory immune profile leading to symptom relief. Despite the clinical and immune benefits of routine exercise, the direct effect of exercise on immune function in clinical pain populations remains unexplored. This review will discuss in more detail the preclinical and clinical research which demonstrates the numerous ways through which multiple types of exercise alter the peripheral immune system. This review closes with the clinical implications of these findings along with suggestions for future research directions.

The Impact of Physical Exercise on Obesity in a Cohort of Southern Italian Obese Children: Improvement in Cardiovascular Risk and Immune System Biomarkers

Background: Childhood obesity (CO) is a serious medical condition affecting approximately 120 million children and adolescents worldwide. It is characterized by a persistent inflammatory state with inflammatory markers overexpressed, which in turn leads to a higher cardiovascular risk. It is well known that physical exercise reduces the inflammatory state in obese children. In the present study, we evaluated various biochemical parameters in obese children performing physical exercise compared to a group of obese sedentary children. Hence, the objective is to identify a panel of biomarkers to prevent numerous obesity-related complications. Methods: We examined two populations: 44 sedentary obese children (OSe), recruited on 5 November 2018 from Santobono−Pausilipon Children’s Hospital, Naples (Italy) of age = 11 ± 3.3 and 30 obese children who practice sport (OSp) of age = 10 ± 2.5. We observed a significant variation in some biochemical parameters such as white blood cells, C-reactive protein (CRP), glycemia and insulinemia. Moreover, we determined the levels of interleukins, chemokines and defensins by ELISA assay. Results: Our results showed a reduction in serum level of glycemia (p-value < 0.001), neutrophils (p-value < 0.05) and CRP (p-value < 0.05), whereas no relevant variations have been reported in insulin levels. Moreover, we found a decrease in serum levels of PDGF-β (p-value < 0.05), IL-9 (p-value < 0.01), IL-6 (p-value < 0.0001), IL-8 (p-value < 0.0001), IP-10 (p-value < 0.01), Eotaxin (p-value < 0.0001) and GM-CSF (p-value < 0.01) in OSp population in comparison to OSe. At the same time, we did not observe any significant variation in serum levels of IL-1ra and IL-17 between the two populations. On the other hand, we found an increase in HNP-1 (p-value < 0.0001) and HBD1 (p-value < 0.01) in OSp if compared to OSe. Conclusions: This study shed light on the role of physical exercise on CO, demonstrating in our population that an early evaluation of some biochemical parameters could be an assumption to prescribe physical exercise in order to monitor and prevent childhood obesity and related disorders.

Self-Perceived Physical Level and Fitness Performance in Children and Adolescents with Inflammatory Bowel Disease

Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.

A Proinflammatory Diet Is Associated with Higher Risk of Peripheral Artery Disease

Peripheral arterial disease (PAD) has a strong relationship with inflammation. However, it is unclear whether the dietary inflammatory potential is associated with PAD. We aimed to address this knowledge gap. The dietary inflammatory index (DII) was obtained using a 24-h dietary recall interview for each individual. Logistic regression models and restricted cubic spline were performed to assess the relationship of DII with the prevalence of PAD. In addition, Spearman correlation analysis and subgroup analysis were also undertaken. In total, 5840 individuals from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were enrolled in our study. Participants in higher DII quartile tended to have higher rates of PAD. The increase in DII scores showed a positive association with PAD after fully multivariate adjustment (OR (odds ratios) = 1.094, 95% confidence interval (CI): 1.022–1.171). The multivariable-adjusted OR and 95% CI of the highest DII index quartile compared with the lowest quartile was 1.543 (95% CI: 1.116–2.133). Subgroup analysis demonstrated that the positive association between DII and PAD was persistent across population subgroups. In conclusion, we report that a proinflammatory dietary pattern is related to a higher risk of developing PAD among US adults.

Benefits of Physical Exercise as Approach to Prevention and Reversion of Non-Alcoholic Fatty Liver Disease in Children and Adolescents with Obesity

Non-alcoholic fatty liver disease (NAFLD) is an important health concern during childhood; indeed, it is the most frequent cause of chronic liver diseases in obese children. No valid pharmacological therapies for children affected by this condition are available, and the recommended treatment is lifestyle modification, usually including nutrition and exercise interventions. In this narrative review, we summarized up-to-date information on the benefits of physical exercise on NAFLD in children and adolescents with obesity. The role of exercise as non-pharmacological treatment was emphasized in order to provide recent advances on this topic for clinicians not deeply involved in the field. Several studies on obese children and adults confirm the positive role of physical activity (PA) in the treatment of NAFLD, but to date, there are no pediatric randomized clinical trials on exercise versus usual care. Among the pathogenic mechanisms involved in the PA effects on NAFLD, the main players seem to be insulin resistance and related inflammation, oxidative stress, and gut dysbiosis, but further evaluations are necessary to deeply understand whether these factors are correlated and how they synergistically act. Thus, a deeper research on this theme is needed, and it would be extremely interesting.