Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis.

Fatigue and musculoskeletal pain are also frequent in patients with psoriasis (PsO) without arthritis (PsA). The current study aimed to assess the impact of an intervention program based on aerobic training to reduce fatigue and musculoskeletal pain in patients with PsO without PsA. A total of 118 male patients with PsO volunteered in the current interventional study and were randomly allocated to the experimental (n = 59) or control group (n = 59). The intervention consisted of a 16-week aerobic training program on a treadmill, three sessions per week, consisting of a warm-up, 35-50 min treadmill exercise (increasing 5 min/4 weeks) at a work intensity of 50-65% of peak heart-rate (increasing 5%/4 weeks), and cooling-down. The functional assessment of chronic illness therapy fatigue scale (FACIT-Fatigue), health assessment questionnaire disability index (HAQ-DI), and visual analog scale (VAS) were compared pre and post intervention. Nutritional intake, maximal aerobic power, lipid profile, serum markers of muscle damage, and body composition were also assessed. When compared to baseline, FACIT-Fatigue, HAQ-DI, and VAS scores were significantly improved without increasing markers of muscle damage. Fat mass percentage, lipid profile, and maximal oxygen consumption were also improved. In conclusion, a 16-week aerobic training program at moderate intensity was safe, well tolerated, and effective in psoriatic patients without PsA. Long-term follow-up studies are required to examine whether these promising results may improve clinical outcomes.

Effects of Resistance Training in Muscle Mass and Markers of Muscle Damage in Adults with Down Syndrome.

Recent studies have emphasized that regular exercise should be encouraged as a key part of care and support for people with Down syndrome (DS). However, muscle hypotonia has traditionally been considered a major barrier to resistance training (RT) in people with DS. The main objective of this study was to analyze the impact of circuit RT on markers of muscle damage. The secondary objective was to assess the influence of a RT program on body composition and work task performance. Thirty-six men with DS were recruited and randomly assigned to perform a circuit RT program with six stations 3 days/week for 12 weeks (n = 18) or to a control group (n = 18). Body composition was assessed by bioelectrical impedance analysis. Serum markers of muscle damage (creatine kinase, myoglobin, and lactate dehydrogenase) were determined at baseline and at the end of training weeks 1, 6, and 12. Work task performance was assessed using the weighted pail-carry test. RT did not induce significant changes in markers of muscle damage during the intervention. Furthermore, muscle mass and work task performance were significantly improved in the exercise group. These findings suggest that circuit RT can be used safely to increase muscle mass and work task performance in young adults with DS. Muscle hypotonia should not be considered a major barrier to exercise in people with DS, provided that qualified staff design and supervise all training sessions.

Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy: Evaluation of Quality of Life and Outcomes.

BACKGROUND: The effects of postoperative radiotherapy on free flap-based breast reconstruction are still controversial. Poor outcomes, breast distortion, and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction, and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. METHODS: Between January of 2013 and December of 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors' institution. Patients were divided into two groups depending on whether they received postmastectomy radiotherapy. Quality of life measured with the BREAST-Q questionnaire, self-reported aesthetic outcomes, and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity were also analyzed as the main surgical outcomes. RESULTS: Mean follow-up time after reconstruction was 23 months (range, 6 to 48 months). No significant difference in quality of life or satisfaction scores were found between patients that underwent postmastectomy radiotherapy and patients who did not receive adjuvant radiotherapy. There were no significant differences in rates of fat necrosis between the groups (11.1 percent versus 13.76 percent; p = 0.75). CONCLUSIONS: Postmastectomy radiotherapy in patients undergoing immediate breast reconstruction with free flaps does not seem to affect quality of life, satisfaction with the outcome, or the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[Association between abdominal obesity and seminal oxidative damage in adults with metabolic syndrome]. / Asociación entre obesidad abdominal y daño oxidativo seminal en pacientes con síndrome metabólico.

BACKGROUND: Abdominal obesity, metabolic syndrome (MS) and oxidative stress may impair seminal quality leading to derangements in fertility. AIM: To identify an association between abdominal obesity and markers of seminal oxidative damage in adults with MS. MATERIAL AND METHODS: Seventy males aged 25 to 40 years, with MS according to ATP-III criteria volunteered for this cross-sectional study. The control group included 70 healthy and normal weight adults. Semen analysis included volume, sperm concentration, motility and normal morphologic features. Body mass index (BMI) and waist circumference (WC) were measured, fat mass was determined by bioelectrical impedance. RESULTS: Sperm concentration and the percentage of sperms with normal motility and morphology were significantly lower in adults with MS, when compared to their healthy normal weight counterparts. Seminal levels of malondialdehyde and 8-hydroxy-2'-deoxyguanosine were significantly higher among participants with MS. Significant correlations were found between WC and seminal markers of oxidative stress. CONCLUSIONS: Individuals with MS had an impaired seminal quality that may be explained, at least in part, by increased seminal oxidative damage.

Asociación entre obesidad abdominal y daño oxidativo seminal en pacientes con síndrome metabólico / Association between abdominal obesity and seminal oxidative damage in adults with metabolic syndrome

Abdominal obesity, metabolic syndrome (MS) and oxidative stress may impair seminal quality leading to derangements in fertility. Aim: To identify an association between abdominal obesity and markers of seminal oxidative damage in adults with MS. Material and Methods: Seventy males aged 25 to 40 years, with MS according to ATP-III criteria volunteered for this cross-sectional study. The control group included 70 healthy and normal weight adults. Semen analysis included volume, sperm concentration, motility and normal morphologic features. Body mass index (BMI) and waist circumference (WC) were measured, fat mass was determined by bioelectrical impedance. Results: Sperm concentration and the percentage of sperms with normal motility and morphology were significantly lower in adults with MS, when compared to their healthy normal weight counterparts. Seminal levels of malondialdehyde and 8-hydroxy-2’-deoxyguanosine were significantly higher among participants with MS. Significant correlations were found between WC and seminal markers of oxidative stress. Conclusions: Individuals with MS had an impaired seminal quality that may be explained, at least in part, by increased seminal oxidative damage.

Low-grade systemic inflammation and leptin levels were improved by arm cranking exercise in adults with chronic spinal cord injury.

OBJECTIVE: To ascertain the effect of arm cranking exercise on improving plasma levels of inflammatory cytokines and adipokines in untrained adults with chronic spinal cord injury (SCI). DESIGN: Longitudinal study. SETTING: Community-based supervised intervention. PARTICIPANTS: Men (N=17) with complete SCI at or below T5 volunteered for this study. Participants were randomly allocated to the intervention (n=9) or control group (n=8) using a concealed method. INTERVENTION: A 12-week arm cranking exercise program of 3 sessions per week consisted of warm-up (10-15min), arm crank (20-30min; increasing 2min and 30s every 3wk) at a moderate work intensity of 50% to 65% of heart rate reserve (starting at 50% and increasing 5% every 3wk), and cool-down (5-10min). MAIN OUTCOME MEASURES: Plasma levels of leptin, adiponectin, plasminogen activator inhibitor-1, tumor necrosis factor-alpha, and interleukin-6 were determined. Furthermore, physical fitness (maximum oxygen consumption [V˙O2max]) and body composition (anthropometric index, waist circumference, and body mass index) were also assessed. RESULTS: Plasma levels of leptin, tumor necrosis factor-alpha, and interleukin-6 were significantly decreased after the completion of the training program. Similarly, the anthropometric index and waist circumference were diminished too. A moderate correlation was found between leptin and the anthropometric index. Finally, V˙O2max was significantly increased, suggesting an improvement of physical fitness in the intervention group. No changes were found in the control group. CONCLUSIONS: Arm cranking exercise improved low-grade systemic inflammation by decreasing plasma levels of inflammatory cytokines. Furthermore, it also reduced plasma leptin levels. Long-term, well-conducted studies are still required to determine whether these changes may improve clinical outcomes of adults with chronic SCI.

Central obesity measurements predict metabolic syndrome in a retrospective cohort study of postmenopausal women / Obesidad abdominal determinada por DEXA como predictor de síndrome metabólico en mujeres postmenopáusicas

Introduction: The various diagnostic classifications in the literature concur as regards the important role of abdominal obesity in the onset and progression of metabolic syndrome. Accordingly, this study was aimed at clarifying whether central obesity measurements assessed by dual X-ray absorptiometry (DXA) may predict metabolic syndrome in Spanish postmenopausal women. Material and methods: This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest (ROI) envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurement and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). Results: During the observation period, 537 women, representing 40.5% of the total studied, met the diagnostic criteria for metabolic syndrome. L1-L4 and L4-L5 abdominal fat mass determinations were associated with the development of metabolic syndrome in all regression models tested, showing an increasing gradient from the lowest to highest quintile. Conclusion: Central adiposity measurements assessed by DXA, especially L1-L4 region of interest, could be considered a powerful predictor of metabolic syndrome in postmenopausal women (AU)

Introducción: En la actualidad se acepta la importancia de la masa grasa abdominal en la fisiopatología del síndrome metabólico tal y como reconocen las diferentes clasificaciones diagnósticas disponibles. Nuestro objetivo fue analizar la utilidad como predictores de síndrome metabólico de marcadores de grasa abdominal obtenidos por DEXA en mujeres postmenopausicas aprovechando su participación en screening rutinarios para el estudio de la densidad mineral ósea. Material y método: El presente estudio de cohortes histórico incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DEXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Además del DEXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Durante el periodo de observación, 537 mujeres, el 40.5% del total de las estudiadas, cumplió los criterios diagnósticos de síndrome metabólico. Los parámetros de masa grasa abdominal obtenidos mediante DEXA fueron significativamente mayores en mujeres postmenopáusicas con síndrome metabólico. Finalmente, la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DEXA se relacionaron con el desarrollo de síndrome metabólico en los modelos de regresión ensayados. Conclusión: La masa grasa abdominal determinada por DEXA, especialmente la región L1-L4, podría recomendarse como predictor de síndrome metabólico en este grupo (AU)

Maternal fat mass may predict overweight/obesity in non-instituzionalized women with intellectual disability / La masa grasa materna como predictor de sobrepeso/obesidad en mujeres con discapacidad intelectual no institucionalizadas

Introduction: Previous studies have found a significant correlation between parents and offspring regarding overweight and obesity in general population at early life stages. However this issue has received no attention in people with intellectual disability (ID). Therefore, the present study was designed to find out potential correlations in overweight/obesity between young adult women with ID living in the family and their parents. Material and methods: In the present observational cross-sectional study, a total of thirty-four women with Down syndrome (n = 34; 22.6 ± 2.1 years; 29.6 ± 3.3 km/m2) were recruited through different community support groups for people with intellectual disabilities. Furthermore, biological mothers (n = 34; 59.6 ± 4.9 years; 28.5 ± 3.2 km/m2) and fathers (n = 34; 61.5 ± 5.3 years; 26.2 ± 2.7 km/m2) volunteered for this study. They all underwent an anthropometric assessment to determine body mass index (BMI). This protocol was approved by an Institutional Ethics Committee. Results: In the studied population, a total of 26 (76.5%) women with ID were overweight/obese. Furthermore, there were 22 (66.6%) overweight/obese mothers and 16(53.3%) fathers. Results also showed significant correlations between participants BMI and their father (r = 0.327; p = 0.0116) and mother BMI (r = 0.412; p < 0.001). Lastly, overweight/obese women presented a stronger correlation with overweight/obese mothers (odds ratio 4.3; 95%CI 2.9-7.3) than fathers (odds ratio 3.1; 95%CI 1.6-4.4). Conclusion: Parental overweight/obesity, especially maternal one, was strongly associated to overweight/obesity in young adult women with DS. Accordingly, there is an urgent necessity of incorporating parents in the intervention programs designed to the prevention and treatment of overweight and obesity in people with ID (AU)

Fundamento y objetivo: Recientes estudios han encontrado en la población general una correlación entre la incidencia de sobrepeso/obesidad de padres e hijos, especialmente a edades tempranas. Sin embargo, este asunto no ha recibido atención en el caso de hijos adultos con discapacidad intelectual no institucionalizados. El presente estudio pretende determinar una posible correlación entre el sobrepeso/obesidad de padres respecto a sus hijas adultas con discapacidad intelectual que viven en el domicilio. Material y método: Se diseñó un estudio de tipo transversal observacional en el que participaron 34 mujeres adultas con síndrome de Down (22,6 ± 2,1 años; 29,6 ± 3,3 km/m2). Asimismo 34 madres (59,6 ± 4,9 años; 28,5 ± 3,2 km/m2) y 34 padres (61,5 ± 5,3 años; 26,2 ± 2,7 km/m2) biológicos participaron voluntariamente. Todos los participante se sometieron a un estudio cinenatropométrico en el que se obtuvo el índice de masa corporal (IMC). Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: El 76,5% de las mujeres con discapacidad intelectual estudiadas presentaba sobrepeso/obesidad. En cuanto a los progenitores, el 66,6% de las madres y el 53.3 de los padres también presentó sobrepeso/obesidad. El IMC de las participantes se correlacionó significativamente con el de sus madres (r = 0,412; p < 0,001) y padres (r = 0,327; p = 0,0116). Por último, las participantes con sobrepeso/obesidad presentaron una fuerte correlación con sus progenitores con sobrepeso/obesidad, especialmente las madres (odds ratio 4,3; 95%CI 2,9-7,3) y en menor medida sus padres (odds ratio 3,1;95%CI 1,6-4,4). Conclusión: La masa grasa de los padres, especialmente la materna, podría recomendarse como predictor de sobrepeso/obesidad de hijas adultas con discapacidad intelectual no institucionalizadas (AU)

Percepción subjetiva del esfuerzo en fútbol profesional: relevancia de los indicadores físicos y psicológicos en el entrenamiento y la competición / Rate of perceived exertion in professional soccer: importance of the physical and psychological factors for training and competition

Este estudio se llevó a cabo para determinar la relación existente entre la carga física y psicológica de entrenamiento de las sesiones precompetitivas, estimada mediante el tiempo de entrenamiento, la frecuencia cardiaca (FC) y la percepción subjetiva del esfuerzo (PSE), con el propio rendimiento físico de los jugadores en partido oficial. Para ello, en 21 jugadores profesionales de la Football Association Championship Division inglesa, se monitorizó la FC, PSE, el tiempo de entrenamiento y el tiempo específico sobre la zona de alta intensidad en todas las sesiones de entrenamiento durante los 5 días previos al partido. Se registró igualmente la distancia total cubierta y la distancia cubierta en alta intensidad de cada jugador en 22 partidos oficiales mediante el sistema multicámara ProZone®. Los resultados indican que los valores reportados de PSE correlacionan con el volumen y la intensidad de entrenamiento desarrollados durante las sesiones preparatorias, y que por lo tanto es una herramienta válida para cuantificar la carga de entrenamiento. No obstante, dentro de las múltiples variables que intervienen en la competición, estos registros de PSE o el promedio de FC durante las sesiones de entrenamiento precompetitivas, no parecen ser variables que permitan predecir el rendimiento condicional de los jugadores en competición oficial (AU)

This study was undertaken to determine the relationship between the precompetitive physical and psychological training sessions load, estimated by the training time, heart rate (HR) and the rate of perceived exertion (RPE), with the physical performance of players in the competitive match. To do this, in 21 professional players from the English Football Association Championship Division, HR, RPE, the training time and the specific training time in the high intensity zone were monitored during all the training sessions through all the 5 previous days before the match. It was also recorded the total distance covered and the total distance covered in the high intensity zone for each player in 22 official matches using the multicamera computerised tracking system ProZone®. The results indicate that the RPE values correlate with the precompetitive training volume and intensity, and therefore it is a valid tool to quantify the training load. However, within multiple variables involved in the competition, the RPE or the average HR data recorded during the precompetitive training sessions do not seem to be variables that can predict the players´ conditional performance during the official matches (AU)

Resistance circuit training reduced inflammatory cytokines in a cohort of male adults with Down syndrome.

BACKGROUND: It is widely accepted that muscle strength plays a key role on functional tasks of daily living and employability in individuals with Down syndrome (DS). Recent studies have also reported resistance training may improve chronic inflammation in other clinical situations. This is the first study conducted to determine the effect of resistance circuit training on low-grade systemic inflammation in adults with DS. MATERIAL/METHODS: A total of 40 young male adults with DS were recruited for the trial through different community support groups for people with intellectual disabilities and their families. They had medical approval for physical activity participation. Twenty-four were randomly assigned to perform resistance circuit training with 6 stations, 3 days per week for 12 weeks. Exercise intensity was based on function of the 8RM assessments. The control group included 16 age-, sex-, and BMI-matched adults with Down syndrome. Plasma levels of leptin, adiponectin, and TNF-a were assessed by commercial ELISA kits. C-reactive protein (CRP) was assessed by nephelometry. Body composition was also determined, measuring fat-free mass percentage and waist circumference (WC). This protocol was approved by our Institutional Ethics Committee. RESULTS: Plasma levels of leptin, TNF-a, and IL-6 were significantly decreased after the completion of the training program, as were fat-free mass and WC. No sports-related injuries or withdrawals from the program were reported during the entire study period. No changes were observed in the control group. CONCLUSIONS: Resistance circuit training improved low-grade systemic inflammation in male sedentary adults with DS.

[A short-term training program reduced acute phase proteins in premenopausal women with metabolic syndrome]. / Reducción de reactantes de fase aguda en mujeres con síndrome metabólico tras 12 semanas de entrenamiento.

INTRODUCTION: It is accepted low grade systemic inflammation plays a key role in metabolic syndrome. Further, several studies have reported it may be considered a therapeutic target. Accordingly, this study was conducted to ascertain the impact of a short-term aerobic training program on acute phase proteins in women with metabolic syndrome. MATERIAL AND METHODS: A total of 135 adult women (38.4 ± 3.3 years) with metabolic syndrome volunteered for this study. Participants assigned to the intervention group underwent a 12-week aerobic training program, 3 sessions/week. The main part of each exercise sessions was performed in a treadmill at moderate intensity (60- 75%HRmax; increasing 5% each 3 weeks) for 25-40 minutes (increasing 5 minutes each 3 weeks). Physical fitness was determined by a continuous maximal incremental test. Further, fat mass percentage and indices of obesity were assessed. Plasmatic levels of C reactive protein (CRP-us) and fibrinogen were determined by nephelometry and HPLC respectively. This protocol was approved by an Institutional Ethics Committee. RESULTS: Aerobic training improved physical fitness and reduced both fat mass percentage and indices of obesity. Compared with baseline, it also reduced significantly plasmatic levels of CRP-us (4.90 ± 0.7 vs. 3.77 ± 0.4 mg/l; p = 0.017) and fibrinogen (3.88 ± 0.4 vs. 3.36 ± 0.2 g/l; p = 0.025). Further, a moderate correlation was found between CRP-us and waist circumference (r = 0.66; p = 0.008). No significant changes were found in controls. CONCLUSION: A short-term, aerobic training program reduced acute phase proteins in young women with metabolic syndrome. Further, long-term, well-conducted studies are still required to determine whether correction of this low-grade inflammation improves clinical outcomes of women with metabolic syndrome.

Fundamento y objetivo: Actualmente se acepta la importancia del estatus proinflamatorio en la fisiopatología del síndrome metabólico. De hecho, ha sido propuesto como diana terapéutica en el manejo clínico de estos pacientes. Por consiguiente este estudio pretende reducir los niveles plasmáticos de reactantes de fase aguda en mujeres con síndrome metabólico mediante un corto programa de entrenamiento. Material y método: Un total de 135 mujeres jóvenes adultas (38,4 ± 3,3 años) con diagnóstico de síndrome metabólico participaron voluntariamente en este estudio. El grupo de intervención se sometió a un programa de entrenamiento aeróbico de 12 semanas, con 3 sesiones/ semana en el que duración e intensidad de la parte principal se incrementaron progresivamente. Los niveles plasmáticos de proteína C-reactiva (PCR) y fibrinógeno se determinaron mediante nefelometría y HPLC respectivamente. También se evaluaron el fitness cardiovascular mediante prueba de esfuerzo máxima e índices de distribución de masa grasa. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Tras completar el programa, se observo una mejora significativa del fitness cardiovascular además de una reducción también significativa de los niveles de fibrinógeno y PCR. Asimismo, se encontraron correlaciones entre niveles de reactantes e índices de distribución de masa grasa, siendo la de mayor fuerza de asociación la establecida entre PCR y perímetro cintura. Conclusión: Un programa de 12 semanas consiguió reducir los niveles de reactantes de fase aguda en mujeres con síndrome metabólico. Futuros estudios longitudinales son necesarios para conocer el impacto del efecto anti-inflamatorio del ejercicio en el manejo de estos pacientes a medio/largo plazo.

Reducción de reactantes de fase aguda en mujeres con síndrome metabólico tras 12 semanas de entrenamiento / A short-term training program reduced acute phase proteins in premenopausal women with metabolic syndrome

Fundamento y objetivo: Actualmente se acepta la importancia del estatus proinflamatorio en la fisiopatología del síndrome metabólico. De hecho, ha sido propuesto como diana terapéutica en el manejo clínico de estos pacientes. Por consiguiente este estudio pretende reducir los niveles plasmáticos de reactantes de fase aguda en mujeres con síndrome metabólico mediante un corto programa de entrenamiento. Material y método: Un total de 135 mujeres jóvenes adultas (38,4 ± 3,3 años) con diagnóstico de síndrome metabólico participaron voluntariamente en este estudio. El grupo de intervención se sometió a un programa de entrenamiento aeróbico de 12 semanas, con 3 sesiones/ semana en el que duración e intensidad de la parte principal se incrementaron progresivamente. Los niveles plasmáticos de proteína C-reactiva (PCR) y fibrinógeno se determinaron mediante nefelometría y HPLC respectivamente. También se evaluaron el fitness cardiovascular mediante prueba de esfuerzo máxima e índices de distribución de masa grasa. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Tras completar el programa, se observo una mejora significativa del fitness cardiovascular además de una reducción también significativa de los niveles de fibrinógeno y PCR. Asimismo, se encontraron correlaciones entre niveles de reactantes e índices de distribución de masa grasa, siendo la de mayor fuerza de asociación la establecida entre PCR y perímetro cintura. Conclusión: Un programa de 12 semanas consiguió reducir los niveles de reactantes de fase aguda en mujeres con síndrome metabólico. Futuros estudios longitudinales son necesarios para conocer el impacto del efecto anti-inflamatorio del ejercicio en el manejo de estos pacientes a medio/largo plazo (AU)

INTRODUCTION: It is accepted low grade systemic inflammation plays a key role in metabolic syndrome. Further, several studies have reported it may be considered a therapeutic target. Accordingly, this study was conducted to ascertain the impact of a short-term aerobic training program on acute phase proteins in women with metabolic syndrome. MATERIAL AND METHODS: A total of 135 adult women (38.4 ± 3.3 years) with metabolic syndrome volunteered for this study. Participants assigned to the intervention group underwent a 12-week aerobic training program, 3 sessions/week. The main part of each exercise sessions was performed in a treadmill at moderate intensity (60- 75%HRmax; increasing 5% each 3 weeks) for 25-40 minutes (increasing 5 minutes each 3 weeks). Physical fitness was determined by a continuous maximal incremental test. Further, fat mass percentage and indices of obesity were assessed. Plasmatic levels of C reactive protein (CRP-us) and fibrinogen were determined by nephelometry and HPLC respectively. This protocol was approved by an Institutional Ethics Committee. RESULTS: Aerobic training improved physical fitness and reduced both fat mass percentage and indices of obesity. Compared with baseline, it also reduced significantly plasmatic levels of CRP-us (4.90 ± 0.7 vs. 3.77 ± 0.4 mg/l; p = 0.017) and fibrinogen (3.88 ± 0.4 vs. 3.36 ± 0.2 g/l; p = 0.025). Further, a moderate correlation was found between CRP-us and waist circumference (r = 0.66; p = 0.008). No significant changes were found in controls. CONCLUSION: A short-term, aerobic training program reduced acute phase proteins in young women with metabolic syndrome. Further, long-term, well-conducted studies are still required to determine whether correction of this low-grade inflammation improves clinical outcomes of women with metabolic syndrome (AU)

Mejora del perfil lipídico y lipoperoxidación mediante entrenamiento de fuerza en adultos con discapacidad intelectual / Resistance training improved lipid profile and lipoperoxidation in adults with intellectual disability

Recientes estudios sugieren que el ejercicio de tipo aeróbico reduce el daño oxidativo en personas con síndrome de Down (SD). Sin embargo, los programas de entrenamiento de fuerza han recibido escasa atención en esta línea de trabajo a pesar de la importancia de ésta en el desarrollo de tareas cotidianas y profesionales en este grupo poblacional. Por consiguiente, se diseño el presente estudio para conocer el impacto de este tipo de programas en la lipoperoxidación de adultos sedentarios con síndrome de Down. Para tal fin, un total de 40 adultos jóvenes varones sedentarios con SD participaron voluntariamente en este estudio. Los participantes se distribuyeron aleatoriamente en un grupo intervención (n=24) que realizó un programa de entrenamiento de fuerza de 12 semanas, 3 sesiones semana. El grupo control (n=16) estaba formado por participantes con SD ajustados en sexo y edad. Los niveles plasmáticos de lipoproteína de baja densidad oxidada (oxLDL) se determinaron mediante ELISA. Además, se determinaron el porcentaje de masa grasa, mediante impedanciometría (BIA), así como el perfil lipídico por procedimientos estándar de laboratorio. Este protocolo fue aprobado por un Comité de Ética Institucional. Tras completar el programa de entrenamiento, se redujeron significativamente los niveles plasmáticos de ox-LDL. También se redujo el porcentaje de masa grasa así como los niveles de colesterol-LDL. Asimismo, se observó un aumento significativo de los niveles de colesterol-HDL. No se registraron lesiones ni abandonos a lo largo de la experiencia. Tampoco se observaron cambios en las variables ensayadas en el grupo control. Se concluye que el entrenamiento de fuerza reduce la lipoperoxidación, expresada como niveles de ox-LDL, en adultos sedentarios con SD. Futuros estudios longitudinales para conocer el impacto de esta mejora en el manejo clínico de personas con SD son aún necesarios (AU)

Resistance training has received less attention than endurance training in individuals with intellectual disability in general and Down syndrome in particular. It would be of great interest to compensate this imbalance given muscle strength is essential on functional tasks of daily living and employability in this group. To achieve this goal, this is the first study conducted to determine the effect of resistance circuit training on lipoperoxidation in sedentary adults with DS, given promising results reported in previous studies focused on aerobic training. A total of forty young male adults with DS were recruited for the trial through different community support groups for people with intellectual disabilities and their families. They all had medical approval for physical activity participation. Twenty-four were randomly assigned to perform a resistance circuit training with 6 stations, 3 days per week for 12 weeks. Exercise intensity was based on function of the 8RM assessments. Control group included 16 age, sex and BMI matched adults with Down syndrome. Plasma levels of oxidized low-density lipoprotein (oxLDL) were assessed by commercial ELISA-kits. Serum lipid profile and fat mass percentage were also determined. This protocol was approved by an Institutional Ethics Committee. When compared to baseline results, plasma levels of oxLDL were significantly decreased after the completion of the training program. Serum lipid profile and fat mass were significantly improved too. Neither sports-related injuries nor withdrawals from the program were reported during the entire study period. Finally, no changes were observed in the control group. It was concluded resistance circuit training improved lipoperoxidation in male sedentary adults with DS. Further, long-term, well-conducted studies are required to determine whether the increased antioxidant system may improve clinical outcomes of adults with DS (AU)

Arm-cranking exercise reduced oxidative damage in adults with chronic spinal cord injury.

OBJECTIVE: To assess the effect of a 12-week arm-cranking exercise program on reducing oxidative damage in untrained adults with chronic spinal cord injury (SCI). DESIGN: Randomized controlled trial. SETTING: Community-based supervised intervention. PARTICIPANTS: Male adults with complete SCI at or below the fifth thoracic level (T5) (N=17) volunteered for this study. Participants were randomly allocated to the intervention (n=9) or control (n=8) group using a concealed method. INTERVENTION: A 12-week arm-cranking exercise program, 3 sessions/wk, consisting of warming-up (10-15min) followed by a main part in arm-crank (20-30min [increasing 2min and 30s every 3wk]) at a moderate work intensity of 50% to 65% of the heart rate reserve (starting at 50% and increasing 5% every 3 weeks) and by a cooling-down period (5-10min). MAIN OUTCOME MEASURES: Plasmatic levels of total antioxidant status as well as erythrocyte glutathione peroxidase activity were measured. Lipid and protein oxidation were determined as malondialdehyde and carbonyl group levels, respectively. Furthermore, physical fitness and body composition were assessed. RESULTS: When compared with baseline results, maximum oxygen consumption was significantly increased (P=.031), suggesting an improvement in physical fitness in the intervention group. Regarding the antioxidant defense system, it was found that both total antioxidant status (P=.014) and erythrocyte glutathione peroxidase activity (P=.027) were significantly increased at the end of the training program. As a consequence, plasmatic levels of malondialdehyde (P=.008) and carbonyl groups (P=.022) were significantly reduced. CONCLUSION: A 12-week arm-cranking exercise program improved the antioxidant defense system in adults with chronic SCI, which may finally attenuate both lipid and protein oxidation in this population.

Mejoras del porcentaje y distribución abdominal de masa grasa en mujeres con discapacidad intelectual tras entrenamiento aeróbico de 10 semanas / A short training program reduced fat mass and abdominal distribution in obese women with intellectual disability

En la actualidad se acepta que la obesidad es un grave problema de salud pública. La situación es aún más preocupante entre las personas con discapacidad intelectual, especialmente entre las mujeres. Afortunadamente recientes estudios sugieren la utilidad del ejercicio como estrategia frente a la obesidad. Sin embargo, la mayoría de estos estudios utilizan grupos mixtos (hombres y mujeres) o varones, siendo escasa la información sobre un grupo homogéneo de mujeres. Por consiguiente nos planteamos como hipótesis que un programa de entrenamiento de 10 semanas podría reducir el porcentaje de masa grasa y la distribución abdominal en mujeres obesas con síndrome de Down. En nuestro estudio participaron 20 mujeres adultas (18-30 años) con un cociente intelectual de 50-69 según la escala Stanford-Binet y diagnóstico citogenético de trisomía 21. Todas presentaban obesidad definida como IMC>30 kg/m2. Once de las participantes se asignaron aleatoriamente al grupo experimental y desarrollaron un programa de entrenamiento de 10 semanas de tipo aeróbico con 3 sesiones/semana. El porcentaje de masa grasa se determinó mediante impedanciometría bioeléctrica (Tanita TBF521). Para obtener el índice cintura/cadera se midieron las circunferencias de la cintura y la cadera utilizando una cinta antropométrica. Nuestro protocolo fue aprobado por un Comité de Ética Institucional. Nuestros resultados confirman que el ejercicio aeróbico redujo significativamente el porcentaje de masa grasa, el índice cintura/cadera y el perímetro de la cintura (p<0,05). Por el contrario no se observaron cambios en el grupo control. Concluimos que un programa de entrenamiento de 10 semanas consiguió mejorar la composición corporal de mujeres obesas con síndrome de Down. Futuros estudios longitudinales bien conducidos y controlados son necesarios para conocer el impacto de esta mejora en el manejo clínico de este grupo.

Recent studies have reported obesity prevalence in people with intellectual disability is even higher than in the general population what may finally lead to impair their health status and increase healthcare costs. Fortunately several studies have reported regular exercise may improve body composition in obese people with and without intellectual disability. To the best of our knowledge this is the first study conducted exclusively in female participants with intellectual disability, in an attempt to keep our sample homogeneous. To date, many studies focused on the influence of regular exercise in people with intellectual disability have recruited mixed (males and females) groups in order to increase their sample size to strengthen research designs. Therefore, we assessed the influence of a 10-week aerobic training program on fat mass percentage and indices of obesity in women with Down syndrome. To get this goal, twenty obese young women with Down syndrome volunteered for this study. Eleven were randomly assigned to perform a 10-week aerobic training program, 3 sessions/week, consisting of warming-up followed by a main part in a treadmill (30-40 min) at a work intensity of 55-65% of peak heart rate and a cooling-down period. Control group included 9 age, sex and BMI matched women with Down syndrome. Fat mass percentage and fat distribution were measured. This protocol was approved by an Institutional Ethics Committee. When compared to baseline, fat mass percentage, waist circumference and waist to hip ratio were significantly reduced after training. Conversely, no changes were reported in controls. It was concluded a 10-week training program reduced fat mass in obese adult women with Down syndrome.

Anti-inflammatory effect of exercise, via reduced leptin levels, in obese women with Down syndrome.

Recent studies have reported that obese young people with Down syndrome suffer from low-grade systemic inflammation. Whereas this condition may be improved in the general population by regular exercise, the problem has received no attention in the case of people with intellectual disability. Therefore, the authors' aim was to assess the influence of aerobic training on plasma adipokines in obese women with Down syndrome. Twenty obese young women with Down syndrome volunteered for this study, 11 of whom were randomly assigned to a 10-wk aerobic-training program. They attended 3 sessions/wk, which consisted of warm-up exercises followed by the main activity on a treadmill (30-40 min) at a work intensity of 55-65% of peak heart rate and ended with a cooling-down period. The control group included 9 women with Down syndrome matched for age, sex, and body-mass index. Fat-mass percentage and distribution were measured, and plasma adipokine levels (leptin and adiponectin) were assessed. In addition, each participant performed a maximal graded continuous treadmill exercise test. These parameters were assessed pre- and postintervention. Aerobic training produced a significant increase in participants' maximal oxygen uptake (20.2 ± 5.8 vs.23.7 ± 6.3 ml · kg-1 · min-1; p < .001), and plasma leptin levels were significantly reduced in the intervention group (54.2 ± 6.7 vs.45.7 ± 6.1 ng/ml; p = .026). Further significant correlations between plasma leptin and indices of obesity were found. In contrast, no significant changes were found in adiponectin levels (p > .05). None of the tested parameters changed in the control group. In conclusion, a 10-week training program reduced leptin levels in obese young women with Down syndrome.

Central obesity measurements predict metabolic syndrome in a retrospective cohort study of postmenopausal women.

INTRODUCTION: The various diagnostic classifications in the literature concur as regards the important role of abdominal obesity in the onset and progression of metabolic syndrome. Accordingly, this study was aimed at clarifying whether central obesity measurements assessed by dual X-ray absorptiometry (DXA) may predict metabolic syndrome in Spanish postmenopausal women. MATERIAL AND METHODS: This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest (ROI) envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurement and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). RESULTS: During the observation period, 537 women, representing 40.5% of the total studied, met the diagnostic criteria for metabolic syndrome. L1-L4 and L4-L5 abdominal fat mass determinations were associated with the development of metabolic syndrome in all regression models tested, showing an increasing gradient from the lowest to highest quintile. CONCLUSION: Central adiposity measurements assessed by DXA, especially L1-L4 region of interest, could be considered a powerful predictor of metabolic syndrome in postmenopausal women.

Introducción: En la actualidad se acepta la importancia de la masa grasa abdominal en la fisiopatología del síndrome metabólico tal y como reconocen las diferentes clasificaciones diagnósticas disponibles. Nuestro objetivo fue analizar la utilidad como predictores de síndrome metabólico de marcadores de grasa abdominal obtenidos por DEXA en mujeres postmenopausicas aprovechando su participación en screening rutinarios para el estudio de la densidad mineral ósea. Material y método: El presente estudio de cohortes histórico incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DEXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Además del DEXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Durante el periodo de observación, 537 mujeres, el 40.5% del total de las estudiadas, cumplió los criterios diagnósticos de síndrome metabólico. Los parámetros de masa grasa abdominal obtenidos mediante DEXA fueron significativamente mayores en mujeres postmenopáusicas con síndrome metabólico. Finalmente, la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DEXA se relacionaron con el desarrollo de síndrome metabólico en los modelos de regresión ensayados. Conclusión: La masa grasa abdominal determinada por DEXA, especialmente la región L1-L4, podría recomendarse como predictor de síndrome metabólico en este grupo.

Maternal fat mass may predict overweight/obesity in non-instituzionalized women with intellectual disability.

INTRODUCTION: Previous studies have found a significant correlation between parents and offspring regarding overweight and obesity in general population at early life stages. However this issue has received no attention in people with intellectual disability (ID). Therefore, the present study was designed to find out potential correlations in overweight/obesity between young adult women with ID living in the family and their parents. MATERIAL AND METHODS: In the present observational cross-sectional study, a total of thirty-four women with Down syndrome (n=34;22.6±2.1 years; 29.6±3.3 km/m2) were recruited through different community support groups for people with intellectual disabilities. Furthermore, biological mothers (n=34;59.6±4.9 years; 28.5±3.2 km/m2) and fathers (n=34; 61.5±5.3 years; 26.2±2.7 km/m2) volunteered for this study. They all underwent an anthropometric assessment to determine body mass index (BMI). This protocol was approved by an Institutional Ethics Committee. RESULTS: In the studied population, a total of 26 (76.5%) women with ID were overweight/obese. Furthermore, there were 22 (66.6%) overweight/obese mothers and 16(53.3%) fathers. Results also showed significant correlations between participants BMI and their father (r = 0.327; p = 0.0116) and mother BMI (r = 0.412; p < 0.001). Lastly, overweight/obese women presented a stronger correlation with overweight/obese mothers (odds ratio 4.3; 95%CI 2.9-7.3) than fathers (odds ratio 3.1; 95%CI 1.6-4.4). CONCLUSION: Parental overweight/obesity, especially maternal one, was strongly associated to overweight/obesity in young adult women with DS. Accordingly, there is an urgent necessity of incorporating parents in the intervention programs designed to the prevention and treatment of overweight and obesity in people with ID.

Fundamento y objetivo: Recientes estudios han encontrado en la población general una correlación entre la incidencia de sobrepeso/obesidad de padres e hijos, especialmente a edades tempranas. Sin embargo, este asunto no ha recibido atención en el caso de hijos adultos con discapacidad intelectual no institucionalizados. El presente estudio pretende determinar una posible correlación entre el sobrepeso/obesidad de padres respecto a sus hijas adultas con discapacidad intelectual que viven en el domicilio. Material y método: Se diseñó un estudio de tipo transversal observacional en el que participaron 34 mujeres adultas con síndrome de Down (22.6±2.1años; 29.6±3.3km/m2). Asimismo 34 madres (59.6±4.9años; 28.5±3.2km/m2) y 34 padres (61.5±5.3años; 26.2±2.7 km/m2) biológicos participaron voluntariamente. Todos los participante se sometieron a un estudio cinenatropométrico en el que se obtuvo el índice de masa corporal (IMC). Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: El 76.5% de las mujeres con discapacidad intelectual estudiadas presentaba sobrepeso/obesidad. En cuanto a los progenitores, el 66.6% de las madres y el 53.3 de los padres también presentó sobrepeso/obesidad. El IMC de las participantes se correlacionó significativamente con el de sus madres (r=0.412;p.

Lo importante sigue siendo participar: ejercicio y discapacidad intelectual / The most important thing is taking part: exercise and intellectual disability

Al hacer una revisión de la literatura especializada se observa un nivel de evidencia cada vez mayor sobre la utilidad del ejercicio en la promoción de la salud y calidad de vida. Sin embargo, escasa atención se ha prestado a aquellas poblaciones que presentan algún tipo de discapacidad, como retraso mental. Este hecho ha obligado a cuidadores, educadores y demás profesionales que trabajan con estas personas a aplicar programas copiados de los que se diseñan para población general. Como su diseño no tenía en cuenta las características anátomo-funcionales de estas personas, por ejemplo su insuficiencia cronotrópica, estos programas se asociaban a frecuentes abandonos, lesiones y en definitiva, a malos resultados. Afortunadamente cada vez son más los grupos de investigación, muchos de ellos Españoles, que tienen a ésta como su principal línea trabajo. Paralelamente, cada vez más Instituciones públicas la incluyen como tema prioritario en sus convocatorias de ayudas a la investigación. De este modo se han publicado recientes estudios que confirman la utilidad de programas de entrenamiento específicos frente a la obesidad, el daño oxidativo, la hipotenía muscular, entre otros procesos prevalentes en este grupo. También se han estandarizado protocolos para la realización en laboratorio de pruebas de esfuerzo máximas y submáximas, lo que mejorará su preparación para los cada vez más numerosos eventos deportivos en los que participan (Campeonatos de España, Europeos, Paralimpiadas, etc.).Por consiguiente, futuros estudios en esta línea de trabajo son aún necesarios para garantizar su consolidación. Máxime, si tenemos en cuenta que los resultados que se están publicando son muy esperanzadores (AU)

It is widely accepted regular exercise may improve both health status and quality of life in general population. However little attention has been paid to individuals with intellectual disability (ID).Considering the fact there was no literature enough in the past, people with ID underwent training programs designed for general population, not for them. Accordingly they did not achieve their goals at the end of the training program. Furthermore these protocols were associated to increased drop-out rates and sport related injuries. Fortunately, the design of modern training programs incorporates many specific variables from the target population, such as chronotropic insufficiency in individuals with Down syndrome. As a consequence, recent intervention programs based on physical activity have improved oxidative damage, obesity, hypotonia, among other prevalent disorders. And many of these paper shave been published by Spanish research groups. For the reasons already mentioned, future studies on this topic are highly required. Mainly if we take into account previous results are highly positive. As well as there is an increasing number of national and international sport events for people with ID (AU)

Experiencia cubana con el uso terapéutico de células madre adultas / Cuban experience with the therapeutic use of adult stem cells

Las investigaciones básicas y clínicas realizadas en los últimos años sobre las células madre y sus posibilidades terapéuticas, son en la actualidad uno de los temas más excitantes de la medicina contemporánea. Ya se han obtenido importantes avances en el estudio y aplicación de las células madre adultas que muestran notables ventajas sobre las embrionarias, pues su manipulación resulta más simple, económica y se pueden obtener del propio individuo que va a ser tratado. Para la introducción en Cuba de la terapia celular regenerativa, en el Instituto de Hematología e Inmunología se seleccionaron como fuentes celulares las células madre adultas derivadas de la médula ósea y las movilizadas a la sangre periférica. Para facilitar la extensión del tratamiento a otros centros hospitalarios, se estandarizó una técnica para la movilización de las células madre hematopoyéticas a la sangre periférica, mediante un factor estimulador de colonias de granulocitos (Filgrastim, de producción nacional) y se desarrolló un método simple, económico y también más tolerable para los enfermos. De esta forma, se ha extendido la terapia celular a 6 provincias cubanas y hasta abril del año 2009 se habían tratado 563 casos con trasplante de células madre adultas autólogas, de los cuales el 81,7 por ciento corresponde a pacientes con enfermedades angiológicas, en los que se ha logrado disminuir significativamente la indicación de amputaciones mayores. También los resultados han sido muy prometedores en las lesiones óseas y procesos periodontales, entre otras enfermedades tratadas. Los resultados obtenidos hasta el momento se pueden considerar como un nuevo logro de la ciencia revolucionaria y de nuestros sistemas nacionales de salud y de ciencia y técnica. El método empleado es un proceder económico y factible para instituciones con recursos limitados(AU)

The basic and clinical researches carried out during past years on the stem cells and its therapeutic possibilities are at present times, one of the most interesting subjects of the contemporaneous medicine. There are advances in the study and application of adult stem cells showing remarkable advantages on the embryonic ones, since its handling is more simple, economic and they are obtained from the own subject to be treated. For the introduction in Cuba of the regenerative cellular therapy in the Institute of Hematology and Immunology the cellular sources selected were the adult stem cells derived from bone marrow and the mobilized ones to the peripheral blood. To make easy the expansion of treatment to other hospital centers, authors standardized a technique for the mobilization of the hematopoietic stem cells to peripheral blood using a granulocyte colony-stimulating factor (Filgrastim, of national production) developing a simple, economic and more tolerable method for patients. In this way, the cellular therapy has been expanded to 6 Cuban provinces and until April, 2009 562 cases with autologous adult stem cells transplant have been treated, from which the 81.7 percent to correspond to patients presenting with Angiology diseases with a significant reduction of major amputations. Also, the results have been very promising in the bone lesions and periodontal processes among other diseases treated. The results obtained until now may be considered as a new achievement of revolutionary science and of our national health systems and of science and technique. The method used is an economic and feasible procedure for the institutions with scarce resources(AU)