Clustering of health risk behaviors in pregnant individuals: Data from the Brazilian risk factor surveillance system for non-communicable chronic diseases.

OBJECTIVE: To investigate the clustering of health risk behaviors (HRB) and its association with demographics, physical exercise, overweight, perception of health, and diseases in Brazilian pregnant people. STUDY DESIGN: This is a cross-sectional study using data from the Risk Factor Surveillance System for Non-communicable Chronic Diseases by Telephone Survey (VIGITEL), the main health survey in Brazil. METHODS: We used data on fruit and vegetable consumption, TV time, tobacco, and alcohol abuse in individuals who reported being pregnant (n = 4553). We used latent class analysis to identify optimal HRB clustering among participants. Multinomial regression (odds ratio [OR] and 95% confidence intervals [95%CI]) was applied to identify factors associated with HRB cluster. RESULTS: Three clustering classes were identified: "without HRB cluster" (i.e., least unhealthy behaviors) (n = 2402, 52,8%), "moderate HRB cluster" (n = 1983, 43,5%), and "high HRB cluster" (i.e., most unhealthy behaviors) (n = 168, 3,7%). Pregnant people aged 35-50 years (OR = 1.89, 95%CI = 1.01; 3.52) who did not practice physical exercise (OR = 1.94, 95%CI 1.11; 3.39) were more likely to be classified as "high HRB cluster". Participants with 9-11 years (OR = 0.11, 95%CI = 0.07; 0.17) and ≥ 12 (OR = 0.05, 95%CI = 0.02; 0.11) years of education had a lower likelihood of being in the "high HRB cluster". CONCLUSION: Three HRB clustering patterns were found in this study. Greater maternal age, low education, and absence of physical exercises increased the chances of being in the high HRB cluster group. Participants with higher educational levels were less likely to be in the High HRB cluster.

Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test.

ABSTRACT: Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.

Impact of acute moderate-intensity aerobic exercise on circulating extracellular vesicles in pregnant and non-pregnant women.

Exercise improves cardiovascular and metabolic health in pregnancy and may represent a non-pharmacological approach to improving pregnancy outcomes. Extracellular vesicles (EVs) are emerging biomarkers of endothelial dysfunction and offer the potential for evaluating vascular health non-invasively during pregnancy. The purpose of this study was to investigate changes in circulating EV levels after an acute bout of moderate-intensity aerobic exercise in healthy pregnant and non-pregnant women. We studied plasma samples from pregnant (N = 13, 13-28 weeks) and non-pregnant (N = 17) women. A pre-exercise blood sample was obtained followed by a 30 min bout of moderate-intensity treadmill-based exercise. Immediately following the exercise, a post-exercise blood draw was collected. Large EVs were isolated from plasma by differential centrifugation and characterized by Western blot and electron microscopy. We quantified circulating EVs by nanoscale flow cytometry. Endothelial EVs were identified as VE-Cadherin+, platelet EVs as CD41+, and leukocyte EVs as CD45+ events. Acute exercise was associated with a significant reduction in levels of circulating endothelial EVs in the non-pregnant group (p = 0.0232) but not in the pregnant group (p = 0.2734). A greater proportion of non-pregnant women (13/17, 76.47%) exhibited a reduction in endothelial EVs compared with their pregnant counterparts (4/13, 30.76%, p < 0.05). We also observed a positive association between measures of fitness (average speed) and baseline levels of platelet (r = 0.5816, p = 0.0159) and total EVs (r = 0.5325, p = 0.0296) in the non-pregnant group but not in pregnant individuals. Collectively, our study highlights that after a matched acute exercise, changes to circulating EV levels differ depending on pregnancy status.

Association between cognitive performance and sarcopenic obesity in older adults with Alzheimer's disease.

Sarcopenic obesity (SO), the co-occurrence of sarcopenia and obesity, is associated with functional loss, frailty, and incapacity in older adults. Recently, SO was associated with reduced cognitive performance in adults. However, no SO studies have been done with older adults with Alzheimer's disease (AD). Objective: The objective of this study was to verify the occurrence of SO and associated factors in 43 older adults with AD. Methods: We applied the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). SO was verified by using dual-emission X-ray absorptiometry. Results: We found five women with SO. Women had higher body fat and lower muscle mass compared with men. There was a significant relationship between body fat and cognitive performance only in men (r=0.65; p<0.01) adjusted by age and education. Men with obesity and aged >75 years had better cognitive performance compared with non-obese men aged <75 years (p=0.010) and women with obesity aged >75 years (p=0.033). Conclusions: Women with AD had higher body fat and lower muscle mass than men. SO occurs in older women with AD. Men with higher body fat showed better cognitive performance, independent of age and education.

A obesidade sarcopênica (SO), coocorrência de sarcopenia e obesidade, está associada à perda funcional, à fragilidade e à incapacidade em idosos. Recentemente, verificou-se que a SO está associada ao desempenho cognitivo reduzido em adultos. No entanto, não foram feitos estudos de SO em idosos com doença de Alzheimer (AD). Objetivo: Verificar a ocorrência de obesidade sarcopênica e fatores associados em 43 adultos idosos com doença de Alzheimer. Métodos: Aplicamos o miniexame do estado mental (MEEM) e a avaliação clínica da demência (CDR). A SO foi verificada utilizando a absorciometria de dupla emissão de raios X. Resultados: Foram classificadas cinco idosas com SO. As mulheres idosas tinham maior gordura corporal e menor massa muscular em comparação com os homens. Houve relação significativa, ajustada por idade e educação, entre gordura corporal e desempenho cognitivo apenas nos homens (r=0,65; p<0,01). Os homens com obesidade e com mais de 75 anos tiveram melhor desempenho cognitivo em comparação com os homens não obesos <75 anos (p=0,010) e com as mulheres com obesidade >75 anos (p=0,033). Conclusões: As mulheres com AD tinham maior gordura corporal e menor massa muscular do que os homens. A SO ocorreu em mulheres mais velhas com AD. Os homens com maior gordura corporal apresentaram melhor desempenho cognitivo, independentemente da idade e da educação.

"We missed the psychological support": A case study about the preparation of the Brazilian bronze medal kata team for the 2019 Pan American Games.

Purpose: The main aim of the study was to describe the key factors involved in the preparation process of the Brazilian bronze medal kata team for the 2019 Pan American Games, focusing on the athletes' perceptions. Methods: Three male athletes from the Brazilian team performed a semistructured interview to identify the following topics: specific time for preparation, training organization, supplementary support, and perception and suggestion about the efficiency of the preparation process. Results: Data from interviews were gathered and coded, and the major themes were summarized as follows after performing content analysis of the data: (a) technical and tactical training took the major part of the preparation; (b) the high level of the coaches helped the team to reach the technical quality of the kata; (c) better psychological support during the preparation could improve the athletes' performance during the training and competition; and (d) the lack of financial support compromised the commitment of the athletes during the training routine. Conclusion: We concluded, based on the athletes' perception, that the most positive factor during preparation for a major competition was the high amount of time focused on technical-tactical training. Even with limitations to performing the physical training, the athletes recognized the importance of the physical component, to increase performance. Financial and psychological support could have helped the team to reach a better result (gold medal) attenuating the training distress.

Circulating small extracellular vesicles increase after an acute bout of moderate-intensity exercise in pregnant compared to non-pregnant women.

The physiological and molecular mechanisms linking prenatal physical activity and improvements in maternal-fetal health are unknown. It is hypothesized that small extracellular vesicles (EVs, ~ 10-120 nm) are involved in tissue cross-talk during exercise. We aimed to characterize the circulating small EV profile of pregnant versus non-pregnant women after an acute bout of moderate-intensity exercise. Pregnant (N = 10) and non-pregnant control (N = 9) women performed a single session of moderate-intensity treadmill walking for 30 min. Plasma was collected immediately pre- and post-exercise, and small EVs were isolated by differential ultracentrifugation. EV presence was confirmed by western blotting for the small EV proteins TSG-101 and flottilin-1. Small EVs were quantified by size and concentration using nanoparticle tracking analysis and transmission electron microscopy. All EV fractions were positive for TSG-101 and flotillin-1, and negative for calnexin. Mean vesicle size at baseline and percent change in size post-exercise were not different between groups. At baseline, pregnant women had higher levels of small EVs compared to controls (1.83E+10 ± 1.25E+10 particles/mL vs. 8.11E+09 ± 4.04E+09 particles/mL, respectively; p = 0.032). Post-exercise, small EVs increased significantly in the circulation of pregnant compared to non-pregnant women after correcting for baseline values (64.7 ± 24.6% vs. - 23.3 ± 26.1%, respectively; F = 5.305, p = 0.035). Further research is needed to assess the functional roles of exercise-induced small EVs in pregnancy.

Characterization of Reproductive and Morphological Variables in Female Elite Futsal Players.

We aimed to characterize the age of onset of training, age at menarche, menstrual periodicity, and performance perception during the menstrual cycle and examined the impact of these reproductive variables on body composition, morphology, and body weight satisfaction in Brazilian elite futsal players. The study consisted of 115 female Brazilian elite futsal players from the top national teams. Data were collected during the twentieth Women's Brazil Futsal Cup. Players were interviewed and self-reported their age of onset of training, age at menarche, menstrual periodicity, and the menstrual period, where they performed best. We also asked for what they considered to be their ideal body weight as well as information related to their training (i.e., volume and frequency). Subsequently, anthropometric measurements (i.e., body mass, height, circumferences, diameters, and skinfold thickness) were performed to estimate the body composition and determine morphological characteristics (e.g., somatotype). Fifty-nine (53.2%) players were postmenarche-trained and 52 (46.8%) were premenarche-trained. Eighteen (16.2%), 65 (58.6%), and 28 (25.2%) were classified as early, normal, and late menarche, respectively. Only 11 (9.6%) and 1 (0.9%) had irregular menstrual cycles and were amenorrheic, respectively. Seventy-three (69.5%), 23 (21.9%), and 9 (8.6%) reported that their game performance was the best at the follicular phase, menses, and luteal phase of the menstrual cycle, respectively. No associations between the four reproductive-related variables were found. Postmenarche-trained players had significant lower age at menarche and higher percentage body fat. The somatotype profile registered lower ectomorphy rate for the postmenarche-trained participants after controlling for covariates. Early menarche group presented higher sum of six skinfold thickness and endomorphy rate compared to normal and late menarche groups. No differences were found when menstrual periodicity groups and best performance groups were compared, except for higher femur width in the regular menstrual cycle group compared to the irregular one. The association between body weight satisfaction and the four reproductive-related variables were not observed. Premenarche-trained Brazilian elite futsal players had the menarche later than the postmenarche-trained athletes. Most of the participants had menarche age classified as "normal," presented "regular" menstrual cycles and perceived to perform better during the follicular phase of the menstrual cycle.

How Many Valid Days Are Necessary to Assess Physical Activity Data From Accelerometry During Pregnancy?

BACKGROUND: The authors examined whether or not ≤3 days wearing Actical® accelerometers provided acceptable results in comparison with the recommendation of ≥4 days in women across gestation. METHODS: A total of 26, 76, and 57 participants at early, mid, and late pregnancy, respectively, were assessed. Participants were instructed to wear the device for 7 days and women who wore it for ≥4 days were included. For each participant, 3, 2, and 1 day(s) were randomly selected. Paired comparisons, intraclass correlations coefficients, and kappa statistics were performed for ≥4 days (criterion) versus 3, 2, and 1 day(s). Averages (in minutes per day) of sedentary time, light, moderate, vigorous, moderate to vigorous physical activity (PA) and steps per day were examined. RESULTS: When 3 valid days were compared with the criterion, no significant differences were found for any gestational period. The intraclass correlations coefficients were "high" for all PA-related variables. The k values varied from .819 to .838 across pregnancy ("strong"). Two and 1 valid day(s) versus the criterion showed significant differences in some PA intensities, reduced intraclass correlations coefficients, "moderate" k values for 2 valid days (.638-.788) and "minimal-to-moderate" k values for 1 valid day (.367-.755). CONCLUSION: In pregnant women during early, mid, and late pregnancy, PA data obtained from 3 valid days of wear was equivalent and agreed with ≥4 valid days.

EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON HANDGRIP STRENGTH AND MUSCULAR VOLUME OF YOUNG WOMEN.

BACKGROUND: High-intensity training methods are generally recommended to increase muscle mass and strength, with training loads of 60-70% 1RM for novice and 80-100% 1RM for advanced individuals. Blood flow restriction training, despite using lower intensities (30-50% 1RM), can provide similar improvements in muscle mass and strength. However, studies commonly investigate the effects of blood flow restriction training in large muscular groups, whereas there are few studies that investigated those effects in smaller muscle groups, such as the muscles involved in grasping (e.g, wrist flexors; finger flexors). Clinically, smaller muscular groups should also be considered in intervention programs, given that repetitive stress, such as repeated strain injuries, affects upper limbs and may lead to chronic pain and incapacity for work. The purpose of the present study was to examine the effects of blood flow restriction training in strength and anthropometric indicators of muscular volume in young women. HYPOTHESIS: The effect of blood flow restriction training in handgrip strength (HGS) and muscular volume of young women can be similar to traditional training, even with lower loads. METHODS: Twenty-eight university students, 18 to 25 years of age, were randomly assigned into two groups, blood flow restriction training (BFR, n = 14) and traditional training (TRAD, n = 14). The anthropometric measures and maximum handgrip strength (MHGS) test were performed before and after the intervention. The participants did three weekly sessions of dynamic concentric contraction exercises on a dynamometer for four weeks (12 sessions). Each session had a time length of five minutes and the intensity was established from a percentage of MHGS at 30-35% in the first week, 40-45% in the second and 50-55% in third/fourth weeks. Three sets of 15-25 handgrip repetitions were performed until a failure with a 30 seconds rest for BFR training and three sets of 8-12 repetitions with one-minute rest for TRAD training. RESULTS: A significant increase was found in the arm muscle circumference (20.6 ± 2.2 vs 21.6 ± 1.7cm) and right MHGS (32.7 ± 4.5 vs 34.3 ± 4.1 kgf) and left MHGS (28.0 ± 5.5 vs 30.9 ± 4.1 kgf) for the BFR training, and the left MHGS (27.6 ± 5.0 vs 31.0 ± 6.1 kgf) for the TRAD training. CONCLUSION: Dynamometer training with blood flow restriction, performed with low to moderate loads, was more effective than the traditional training in increasing HGS and muscle volume in young women. LEVEL OF EVIDENCE: 2b.

Determination of minimal recording period to assess resting heart rate variability during pregnancy.

Traditionally, resting heart rate variability (rHRV) is measured for 10 min using the last 5 min for analyses (e.g., criterion period). It is unknown whether the measurement period can be shortened in pregnant women as there are currently no established standards. We aimed to compare shorter time segments (e.g., from the 1st to 10th minutes) of the parasympathetic index natural logarithm transformation of root mean square of successive R-R differences (Ln rMSSD) with the criterion period in pregnant and nonpregnant women. Twelve pregnant (age: 30.8 ± 3.4 years; gestational age: 20.1 ± 5.0 weeks) and 15 nonpregnant women (age: 29.8 ± 4.0 years) were included. rHRV was measured using a portable heart rate monitor for 10 min while sitting. Ln rMSSD difference/agreement between shorter time segments and criterion period was analyzed. The result observed between the 4th-5th minutes was the shortest time segment not different from/highly agreed with the criterion period in pregnant women (difference [95% confidence interval (CI)]: -0.10 [-0.22 to 0.02]/bias ± 1.96 × SD: -0.06 [-0.38 to 0.25]). In nonpregnant women, the 2nd-3rd-minute segment was the shortest with similar results (difference [95% CI]: -0.04 [-0.15 to 0.07]/bias ± 1.96 × SD: -0.03 [-0.39 to 0.32]). The Ln rMSSD was found to be stable from the 5th-10th minutes and the 3rd-10th minutes in pregnant and nonpregnant women, respectively. A shortened rHRV assessment can increase its applicability in clinical/exercise-training settings. Novelty Ln rMSSD can be measured for 5 min in pregnant women, with the last 1-min segment analyzed. The last 1-min segment from 3 min can be used for rHRV measurement in nonpregnant women. The shortened rHRV assessment can facilitate its applicability in clinical/exercise-training settings.

Greater energy demand of exercise during pregnancy does not impact mechanical efficiency.

Pregnant women are recommended to engage in 150 min of moderate-intensity physical activity per week to reduce pregnancy complications. Many women struggle to remain physically active throughout pregnancy, and there is no consensus about whether women adopt a less efficient movement pattern as they progress through pregnancy and experience gestational weight gain. This study assessed the change in energy expenditure and mechanical efficiency in pregnant women (PREG; n = 10) when performing a walking treadmill task in early, mid, and late pregnancy and also compared with an age- and body mass index-matched, nonpregnant (CON; n = 10) group. On average, the PREG group gained within the Institute of Medicine's gestational weight gain guidelines (11.6 ± 3.6 kg) and were all inactive (measured using accelerometry), except for 1 participant, by the third trimester, as per the 2019 Canadian physical activity guidelines for pregnant women. Energy expended to complete the walking task increased throughout pregnancy and was higher than the controls (111.5 ± 24.6 kcal) in mid and late pregnancy (139.0 ± 22.2 kcal, p = 0.02, and 147.3 ± 24.6 kcal, p = 0.005, respectively), but not early pregnancy (129.9 ± 18.9 kcal, p = 0.08). Walking mechanical efficiency was similar within pregnant women at each time point and compared to nonpregnant controls. Our findings add to the growing body of evidence demonstrating that pregnant women can safely perform physical activity by showing that walking mechanical efficiency is unchanged at low to moderate intensities. Novelty Energy demand during exercise increases proportionally to weight gain across pregnancy trimesters. However, mechanical efficiency remains unchanged during low- to moderate-intensity walking.

Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures. METHODS: Ten databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles were broken down into papers that used the current 2009 IOM GWG guidelines and those that used others. A meta-analysis was conducted for studies using the 2009 guidelines examining the prevalence of discordant GWG across cultural groups. RESULTS: The review included 86 studies. Overall, 69% of women experienced discordant GWG irrespective of culture. White women experienced excessive GWG most often, and significantly more than Asian and Hispanic women; Black women had a higher prevalence of excessive GWG than Hispanic and Asian women; however, this difference was not significant. CONCLUSIONS: The majority of women experience excessive GWG, with White women experiencing this most often. Culturally diverse GWG guidelines are needed to individualize antenatal care and promote optimal maternal-fetal health outcomes across cultural groups.

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits.

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive. CONCLUSIONS: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.

Effect of water- versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents.

To compare water- versus land-based exercise programs, as part of a multidisciplinary intervention, on physical fitness and health-related quality of life in overweight and obese adolescents. A total of 151 overweight and obese adolescents (age: 13.2±1.8years) were divided into: 1) a water-based intervention (WB; n=28); 2) a land-based intervention (LB; n=57); and 3) a control group (CG; n=66). Anthropometric measures, body composition, flexibility, abdominal strength/endurance, cardiorespiratory fitness and health-related quality of life were assessed prior and by the end of a 16-week intervention. Both the water- and land-based interventions were part of a multidisciplinary program focusing on behavioral changes. Fat Mass (%) was significantly reduced in both intervention groups and a higher progression was observed in the WB group (-9.8±7.2% versus -6.1±6.2%; p<0.05 for pre-to-post changes within-groups). However, LB increased more abdominal strength than WB (69.6±165.8% versus 53.4±83.4%; p<0.05) and significantly increased social (19.7±88.8%), psychosocial (5.1±15.1%) and total score (6.3±14.8%), which was observed in neither WB nor CG. The intervention groups did not change body weight (WB: -1.7±5.3%; LB: 0.1±3.4%; p>0.05 for both groups) and increased (p<0.05) fat-free mass (WB: 4.6±4.0%; LB: 4.4±4.1%), VO2max (WB: 9.3±7.8%; LB: 11.0±13.4%), and physical dimension of quality of life (WB: 9.2±17.2%; LB: 8.9±18.0%) differently of what was observed in CG. The physical dimension improvement observed in the land-based and water-based samples was associated with decreased percentage fat mass (r=0.282 and 0.229; p<0.05). We suggest water- and land-based physical exercises within a multidisciplinary program promote similar improvements in body composition, physical fitness and health-related quality of life in overweight and obese adolescents.

Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents.

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.

[Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight]. / Parâmetros físicos, clínicos e psicossociais de adolescentes com diferentes graus de excesso de peso.

OBJECTIVE: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity. METHODS: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study. This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05. RESULTS: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weight increased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately. CONCLUSION: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed.

Parasympathetic cardiac activity is associated with cardiorespiratory fitness in overweight and obese adolescents.

The aim of this study was to investigate the association between cardiac parasympathetic activity and cardiorespiratory fitness, insulin, and hemodynamic profile in overweight and obese adolescent girls and boys (aged 12-16 years). Data were taken from the Multidisciplinary Obesity Treatment Program. Only post-intervention measurements are presented herein. Body composition, cardiorespiratory fitness, blood pressure, and metabolic profile (insulin and glucose profile) of adolescents were assessed. Cardiac parasympathetic activity was determined by resting heart rate variability, which was analyzed using a heart rate monitor. Greater parasympathetic cardiac activity was associated with higher levels of cardiorespiratory fitness in both girls and boys (0.375 ≤ r ≤ 0.900), while the sympathetic-vagal balance was negatively related to maximal oxygen uptake (VO2max) in girls (r = 0.478). An association between lower parasympathetic activity and insulin resistance was noted in girls (mean of R-R intervals [RRmean] and homeostasis model assessment insulin-resistance index [HOMA-IR]: r = -0.678), while greater systolic blood pressure (SBP) and lower parasympathetic activity were associated in both sexes (RRmean and SBP: r = -0.526; high frequency [HF (nu)] and SBP: r = -0.754). In conclusion, autonomic nervous system activity was associated with cardiorespiratory fitness, insulin resistance, and SBP in overweight and obese adolescents. The identification of these potential relationships assists with the establishment of future long-term exercise interventions that evaluate the improvements in parasympathetic nervous system activity, in addition to metabolic profile and cardiorespiratory fitness in overweight and obese adolescents.

Longitudinal changes in cardiac autonomic function and aerobic fitness indices in endurance runners: a case study with a high-level team.

To determine the effects of preparatory phase training on aerobic parameters, resting heart rate variability (HRV) and 5-km performance of high-level endurance runners and the relationship between the percentage change (% change) of resting HRV with the % change of aerobic parameters and 5-km performance. Six runners were assessed before and after seven weeks of training. The aerobic parameters were determined in an incremental test. The HRV was assessed by a heart rate monitor. Athletes performed a 5-km running test in a track. The analysis revealed 'likely' and 'very likely' improvements for velocity associated with maximal oxygen uptake ([Formula: see text]O2max) (20.0±1.0 km·h(-1) to 21.2±0.6 km·h(-1)) and 5-km performance (18.0±0.4 km·h(-1) to 18.9±0.7 km·h(-1)), respectively, as well as 'likely' decrease in high frequency (41.4±18.5 nu to 30.4±14.3 nu), and increase in low frequency (58.5±18.5 nu to 69.6±14.3 nu) band densities. The variation in the velocity associated with [Formula: see text]O2max showed the highest correlation with 5-km performance (r=0.95). The % change in the square root of the mean sum of the squared differences between R-R intervals and standard deviation 1 were highly correlated with variation in 5-km performance (r=0.69 and 0.66). Changes in the velocity associated with [Formula: see text]O2max and vagally mediated HRV were highly associated with 5-km running performance within the investigated team. These results have important implications because these parameters can be assessed longitudinally to monitor adaptation to training.

Parent-proxy perception of overweight adolescents' health-related quality of life is different according to adolescent gender and age and parent gender.

UNLABELLED: This study assessed health-related quality of life (HRQoL) reported by overweight adolescents and compared to their parent-proxy perception of HRQoL, according to adolescent gender, adolescent age, and parent gender. Patients and a total of 179 adolescents aged 10 to 18 years with excess weight were evaluated for perceived HRQoL prior to beginning a weight-loss intervention, using the Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaire, estimating quality of life in the physical, emotional, social, and school domains, as well as index measures of psychosocial and overall quality of life. Parents completed the same questionnaire estimating his or her child's HRQoL. Compared to their child's self-report, parents underestimated all the domains of HRQoL except the school domain. Parents underestimated all the domains of HRQoL among boys; however, they only underestimated the physical domain among girls. Comparisons between parent-proxy perception and self-report of the adolescent according to adolescent's age revealed that parents underestimated their children's HRQoL in the younger adolescents (10 to 13 years) for all except for the school domain and underestimated only the physical domain in older adolescents (14 to 18 years). The same comparison between parent-proxy perception and their child's self-report of HRQoL according to parent gender showed that mothers underestimated HRQoL in all domains except for the school domain, while fathers only underestimated the school domain. CONCLUSION: The differences between self-report of overweight adolescent and perceptions of their parents about the HRQoL of their children are influenced by adolescent gender and age and parent gender.

Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents.

This study aims to assess the effects of a 16-week multidisciplinary program of obesity treatment on the control of metabolic syndrome (MS) and dyslipidemia in obese adolescents. Eighty-six adolescents aged 10-18 years were allocated in either the intervention group (IG; n = 44) or control group (CG; n = 42). IG was submitted to a multidisciplinary intervention based on cognitive behavioral therapy that aimed to modify eating habits and exercise behavior. We analyzed, before and after the intervention period, anthropometric parameters, body composition, bone mineral density, cardiorespiratory fitness, blood pressure, glucose, insulin, and lipid profile of the subjects. MS was classified according to International Diabetes Federation (2007) and the presence of dyslipidemia according to Back et al. (Arq Bras Cardiol 85:4-36, 2005). In the beginning of the intervention, the median number (range) of risk factors for MS present was 2.0 (0.0-5.0) in the IG and 2.0 (0.0-4.0) in the CG. After the intervention, this parameter reduced significantly in the IG (1.0 (0.0-5.0); p = 0.004) while no change was observed in the CG (2.0 (0.0-4.0); p = 0.349). In addition, we observed improvements in body mass index, waist circumference, hip circumference, maximal oxygen uptake, absolute and relative body fat, systolic blood pressure, diastolic blood pressure, and total cholesterol in the IG which was not identified in the CG. Conclusio n: We suggest that a 16-week multidisciplinary intervention based on cognitive behavioral therapy was adequate to reduce risk factors for MS in obese adolescents.