Vigorous-intensity exercise as a modulator of cardiac adipose tissue in women with obesity: a cross-sectional and randomized pilot study.

Cardiac adipose tissue (CAT) has become an important target for the reduction of disease risk. Supervised exercise programs have shown potential to "significantly" reduce CAT; however, the impact of different exercise modalities is not clear, and the relationships between CAT, physical activity (PA) levels and fitness (PFit) remain unknown. Therefore, the purpose of this study was to analyze the relationships between CAT, PA and PFit, and to explore the effects of different exercise modalities in a group of women with obesity. A total of 26 women (age: 23.41 ± 5.78 years-old) were enrolled in the cross-sectional study. PA, cardiorespiratory fitness, muscular strength, body composition and CAT were evaluated. The pilot intervention included 16 women randomized to a control (CON, n=5), high intensity interval training (HIIT, n = 5) and high-intensity circuit training (HICT, n=6) groups. Statistical analysis showed negative correlations between CAT and vigorous PA (VPA) (r s=-0.41, p=0.037); and between percent body fat (%BF), fat mass (FM), and all PA levels (r s=-0.41- -0.68, p<0.05); while muscle mass was positively associated with moderate-to-vigorous PA, and upper-body lean mass with all PA levels (r s =0.40-0.53, p<0.05). The HICT intervention showed significant improvements (p<0.05) in %BF, FM, fat free mass, and whole-body and lower extremities lean mass and strength after three weeks; however, only leg strength and upper extremities' FM improved significantly compared to CON and HICT. In conclusion, although all types of PA showed a positive influence on body fat content, only VPA significantly impacted on CAT volume. Moreover, three weeks of HICT induced positive changes in PFit in women with obesity. Further research is needed to explore VPA levels and high-intensity exercise interventions for short- and long-term CAT management.

Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review.

Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Dysfunctional exercise (DEX) is a symptom of eating disorders (ED) that precedes, maintains and exacerbates ED pathology. Health professionals struggle to clinically address and manage DEX as little information is available about its assessment and safe management. The current review provides a comprehensive summary of the medical and physiological complications of ED that may be exacerbated by exercise and outlines when exercise may be contraindicated or used in a modified or cautionary way. The literature review yielded six categories of complications: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Comparison of two-dimensional and three-dimensional U-Net architectures for segmentation of adipose tissue in cardiac magnetic resonance images.

The process of identifying cardiac adipose tissue (CAT) from volumetric magnetic resonance imaging of the heart is tedious, time-consuming, and often dependent on observer interpretation. Many 2-dimensional (2D) convolutional neural networks (CNNs) have been implemented to automate the cardiac segmentation process, but none have attempted to identify CAT. Furthermore, the results from automatic segmentation of other cardiac structures leave room for improvement. This study investigated the viability of a 3-dimensional (3D) CNN in comparison to a similar 2D CNN. Both models used a U-Net architecture to simultaneously classify CAT, left myocardium, left ventricle, and right myocardium. The multi-phase model trained with multiple observers' segmentations reached a whole-volume Dice similarity coefficient (DSC) of 0.925 across all classes and 0.640 for CAT specifically; the corresponding 2D model's DSC across all classes was 0.902 and 0.590 for CAT specifically. This 3D model also achieved a higher level of CAT-specific DSC agreement with a group of observers with a Williams Index score of 0.973 in comparison to the 2D model's score of 0.822.

Concordance between Laboratory and Field Methods for the Assessment of Body Fat in Olympic Combat Athletes: Analysis of the Influence of Adiposity.

Combat sports athletes competing in the same discipline exhibit notable and substantial differences in body weight, body composition (BC) and adiposity. No studies have considered the influence of adiposity levels in the agreement between different BC assessment methods. The aim of this study was to analyze the influence of adiposity in the agreement between different methods used to estimate relative body fat (%BF) in Olympic combat sport athletes. A total of 38 male athletes were evaluated using air displacement plethysmography and dual-energy X-ray absorptiometry (DXA) as laboratory methods, and bioelectrical impedance analysis (BIA), near-infrared interactance (NIR) and anthropometry as field methods. All methods were compared to DXA. Agreement analyses were performed by means of individual intraclass correlation coefficients (ICCs) for each method compared to DXA, Bland−Altman plots and paired Student t-tests. The ICCs for the different methods compared to DXA were analyzed, considering tertiles of %BF, tertiles of body weight and type of sport. For the whole group, individual ICCs oscillated between 0.806 for BIA and 0.942 for anthropometry. BIA showed a statistically significant underestimation of %BF when compared to DXA. The agreement between every method and DXA was not affected by %BF, but it was highest in athletes at the highest %BF tertile (>13%). The ICC between NIR and DXA was poor in 72−82 kg athletes. Our results indicate that field methods are useful for routine %BF analysis, and that anthropometry is particularly appropriate, as it showed the highest accuracy irrespective of the athletes' adiposity.

Progressive resistance exercise as complementary therapy improves quality of life and body composition in anorexia nervosa: A randomized controlled trial.

BACKGROUND: and purpose: Exercise has not typically been used as an adjunct in treatment of anorexia nervosa (AN). This study aimed to examine the effects of progressive resistance exercise (PREx) on perceived quality of life (QoL) and body composition in adolescents with AN. MATERIALS AND METHODS: Forty-four adolescents diagnosed with AN were randomly allocated to either PREx or control groups after hospitalization. The PREx group completed twenty-four PREx sessions over two months including three sets of 8-10 repetitions of eight whole-body exercises at a moderate intensity. QoL and body composition were evaluated at baseline and after two months using Health Questionnaire Short-Form 36 (SF-36) and anthropometric measurements. RESULTS: At completion, forty-one participants (n = 19 PREx, and n = 22 controls) with mean age of 12.78 ± 0.88 years and mean body mass index of 18 ± 2.2 kg/m2 were analyzed. Significant group x time effects were found on SF-36 role physical (RP) scores. Significant improvements with large effect sizes (d > 0.72) were found in RP, and arm circumferences in the PREx group. Spearman association analyses between percent change in anthropometric variables and change in QoL scores showed positive associations with moderate-to-large effect sizes in the PREx group among the following variables: mid-thigh-circumference, physical functioning (PF) and general health (GH); calf-circumference relaxed and body pain; biceps skinfold and GH scores; triceps-skinfold, and role physical (RP) and vitality (VT); supraspinale-skinfold and RP and VT; mid-thigh-skinfold and calf-skinfold and VT. CONCLUSION: PREx after hospitalization enables modest positive changes in QoL associated to anthropometric changes in adolescents with AN without adverse effects on weight recovery.

Physical Fitness-Not Physical Activity Levels-Influence Quality of Life in Anorexia Nervosa.

Background: Incorporating physical activity (PA) has been a challenge for health care professionals working with anorexia nervosa (AN) patients. This has contributed to partial physical fitness (PFit) recovery that persists after weight restoration. Objective: This cross-sectional study aimed to examine the relationships between PA, sedentary behaviors, PFit, and quality of life (QoL) in a group of adolescents after hospitalization. Methods: QoL, PA, and sedentary behaviors were measured using the Health-Questionnaire Short-Form 36 (SF-36) and accelerometers, while PFit was assessed through cardiorespiratory fitness, body composition (anthropometry), and strength (six repetition maximum) tests in a total of 63 patients. Results: Light-PA (LPA), moderate-PA (MPA), moderate-to-vigorous-PA (MVPA), and relative sedentary time (%ST) did not meet the recommendations (p < 0.001). Only 22% of the patients met MVPA criteria, and ~82% exceeded %ST. SF-36 scores were lower than normative values except the physical component scale. Absolute cardiorespiratory fitness was reduced (p < 0.001) in 84% of the patients, and was positively associated to body weight, body mass index (BMI), circumferences, and muscle areas. Additional positive significant relationships were found between QoL, muscular strength, and body composition, and negative associations between vigorous-to-very vigorous PA and BMI, skinfolds, and percent body fat. Regression analyses revealed lower body strength as an explanatory factor for improved QoL (OR 1.03, 95%CI 1.00−1.07). Conclusions: PFit and QoL scores are poor after hospitalization. LPA, MPA, and MVPA do not meet recommendations. PFit management­with emphasis on improving muscular fitness­may be a valuable strategy for QoL improvement in AN after hospitalization.

Spectral analysis of ultrasound radiofrequency backscatter for the identification of epicardial adipose tissue.

Purpose: The coronary arteries are embedded in a layer of fat known as epicardial adipose tissue (EAT). The EAT influences the development of coronary artery disease (CAD), and increased EAT volume can be indicative of the presence and type of CAD. Identification of EAT using echocardiography is challenging and only sometimes feasible on the free wall of the right ventricle. We investigated the use of spectral analysis of the ultrasound radiofrequency (RF) backscatter for its potential to provide a more complete characterization of the EAT. Approach: Autoregressive (AR) models facilitated analysis of the short-time signals and allowed tuning of the optimal order of the spectral estimation process. The spectra were normalized using a reference phantom and spectral features were computed from both normalized and non-normalized data. The features were used to train random forests for classification of EAT, myocardium, and blood. Results: Using an AR order of 15 with the normalized data, a Monte Carlo cross validation yielded accuracies of 87.9% for EAT, 84.8% for myocardium, and 93.3% for blood in a database of 805 regions-of-interest. Youden's index, the sum of sensitivity, and specificity minus 1 were 0.799, 0.755, and 0.933, respectively. Conclusions: We demonstrated that spectral analysis of the raw RF signals may facilitate identification of the EAT when it may not otherwise be visible in traditional B-mode images.

Effects of a Short-Term Resistance-Training Program on Heart Rate Variability in Children With Cystic Fibrosis-A Randomized Controlled Trial.

Background: Cystic fibrosis (CF) affects the autonomic nervous system (ANS) and exercise in healthy children modulates the interaction between sympathetic and parasympathetic activity. This study aimed to evaluate the effects of a short-term resistance exercise program on heart rate variability (HRV) in children and adolescents with CF. Methods: A randomized controlled trial was carried out in children diagnosed with CF aged 6-18 years. Individuals were divided into two groups: control (CON) and resistance-training (EX). Individuals in the EX group completed an individualized guided resistance program (5-RM-60-80%) for 8 weeks (3 sessions of 60 min/week). Upper and lower limbs exercises (seated bench press, seated lateral row, and leg press) were used. HRV was measured using a Suunto watch with subjects in lying position. Results: Nineteen subjects (13 boys) were included (CON = 11; and EX = 8). Mean age was 12.2 ± 3.3, FEV1 (forced expiratory volume in the first second) z-score was 1.72 ± 1.54 and peak oxygen consumption (VO2peak) 42.7 ± 7.4 mL.Kg-1.min-1. Exercise induced significant changes in the frequency-domain variables, including a decrease in LF power (p = 0.001, d = 0.98) and LF/HF ratio (p = 0.020, d = 0.92), and an increase in HF power (p = 0.001, d = -0.97), compared to the CON group. No significant changes were found for time-domain variables, although increases with a moderate effect size were seen for SDNN (p = 0.152, d = -0.41) and RMSSD (p = 0.059, d = -0.49) compared to the CON group. Conclusion: A short-term resistance exercise-training program was able to modulate HRV in children and adolescents with CF presenting mild to moderate lung function impairment and good physical condition. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04293926.

Physical exercise as a tool to minimize the consequences of the Covid-19 quarantine: An overview for cystic fibrosis.

Coronavirus (SARS-CoV-2) outbreak leading to the coronavirus disease (Covid-19) has become a global pandemic. Patients with Cystic fibrosis are considered of major risk, as respiratory tract infections are more severe than in the general population, with a higher risk of complications and a negative impact on lung function. The performance of physical exercise is considered as key for its well-known general benefits and also as a complementary method to help airway clearance. Therefore, physical exercise is also considered as key in the therapeutic strategy during the quarantine period. However, the impossibility to perform exercise with appropriate prescription and monitoring is of considerable worry to health care professionals. Thus, alternative strategies, such as online measures to monitor this therapy and, consequently, to achieve a safe and effective dose are highly needed. Exercise regimens should include strength and endurance, as well as balance and flexibility exercises. Patients are highly encouraged to participate in exercise programs to maintain fitness and exercise should be continued during the quarantine period. This commentary provides a summary of the main effects and benefits of physical exercise, as well as the main recommendations for its adequate execution, including exercise modality, frequency, intensity, and volume.

Development and evaluation of a method for segmentation of cardiac, subcutaneous, and visceral adipose tissue from Dixon magnetic resonance images.

Magnetic resonance imaging (MRI) has evolved into the gold standard for quantifying excess adiposity, but reliable, efficient use in longitudinal studies requires analysis of large numbers of images. The objective of this study is to develop and evaluate a segmentation method designed to identify cardiac, subcutaneous, and visceral adipose tissue (VAT) in Dixon MRI scans. The proposed method is evaluated using 10 scans from volunteer females 18- to 35-years old, with body mass indexes between 30 and 39.99 kg / m 2 . Cross-sectional area (CSA) for cardiac adipose tissue (CAT), subcutaneous adipose tissue (SAT), and VAT, is compared to manually-traced results from three observers. Comparisons of CSA are made in 191 images for CAT, 394 images for SAT, and 50 images for VAT. The segmentation correlated well with respect to average observer CSA with Pearson correlation coefficient ( R 2 ) values of 0.80 for CAT, 0.99 for SAT, and 0.99 for VAT. The proposed method provides accurate segmentation of CAT, SAT, and VAT and provides an option to support longitudinal studies of obesity intervention.

Effects of resistance training on MRI-derived epicardial fat volume and arterial stiffness in women with obesity: a randomized pilot study.

AIM: To date, few studies have analyzed the effects of exercise on cardiac adipose tissue. Overall, exercise programs did not meet the recommendations for significant weight loss, the utilization of resistance training was minimal, and the conclusions derived from these studies have diminished exercise as a strategy for cardiac fat loss. PURPOSE: The objective of this pilot study was to analyze the effects of 3-week high-intensity, moderate-volume muscular endurance resistance training (RT) on cardiac fat and arterial stiffness. METHODS: A total of 11 young females with obesity, BMI = 34.13 (± 3.16) kg/m2 (n = 5 control, n = 6 intervention) completed the study. Absolute strength was assessed using one repetition maximum test (1RM) for bench press (BP) and leg press (LP), and relative strength was calculated using body weight (BW) as BP-to-BW and LP-to-BW ratio. Magnetic resonance was used to quantify epicardial and paracardial adipose tissue (EAT and PAT) volume, and applanation tonometry was used to assess arterial stiffness by estimating pulse wave velocity (PWV). RESULTS: EAT and PAT volumes (ml) showed significant interaction effects (p = 0.037 and p = 0.031), and very large changes (d > 1) of EAT (p = 0.006) and PAT (p = 0.036) in the intervention group. In addition, strength was significantly improved, including BP (p = 0.003), LP (p = 0.001), BP-to-BW ratio (p = 0.001), and LP-to-BW ratio (p = 0.002), while no changes were found in PWV. CONCLUSIONS: High-intensity, moderate-volume RT, designed to enhance muscular endurance following the recommendations reduces EAT and PAT volumes, improves physical fitness in females with obesity, and has no negative effects on arterial stiffness.

The role of MRI in understanding the underlying mechanisms in obesity associated diseases.

Obesity and its possible association with diseases including diabetes and cardiovascular diseases have been studied for decades for its impact on healthcare. Recent studies clearly indicate the need for developing accurate and reproducible methodologies for assessing body fat content and distribution. Body fat distribution plays a significant role in developing an insight in the underlying mechanisms in which adipose tissue is linked with various diseases. Among imaging technologies including computerized axial tomography (CAT or CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS), MRI and MRS seem to be the best emerging techniques and together are being considered as the gold standard for body fat content and distribution. This paper reviews studies up to the present time involving different methodologies of these two emerging technologies and presents the basic concepts of MRI and MRS with required novel image analysis techniques in accurate, quantitative, and direct assessment of body fat content and distribution. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.

Muscle function and body composition profile in adolescents with restrictive anorexia nervosa: does resistance training help?

PURPOSE: The aim of this study was to analyze the effects of short-term resistance training on the body composition profile and muscle function in a group of Anorexia Nervosa restricting type (AN-R) patients. METHODS: The sample consisted of AN-R female adolescents (12.8 ± 0.6 years) allocated into the control and intervention groups (n = 18 each). Body composition and relative strength were assessed at baseline, after 8 weeks and 4 weeks following the intervention. RESULTS: Body mass index (BMI) increased throughout the study (p = 0.011). Significant skeletal muscle mass (SMM) gains were found in the intervention group (p = 0.045, d = 0.6) that correlated to the change in BMI (r = 0.51, p < 0.031). Meanwhile, fat mass (FM) gains were significant in the control group (p = 0.047, d = 0.6) and correlated (r > 0.60) with change in BMI in both the groups. Significant relative strength increases (p < 0.001) were found in the intervention group and were sustained over time. CONCLUSIONS: SMM gain is linked to an increased relative strength when resistance training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery. Implications for Rehabilitation Anorexia Nervosa Restricting Type (AN-R) AN-R is a psychiatric disorder that has a major impact on muscle mass content and function. However, little or no attention has been paid to muscle recovery. High intensity resistance training is safe for AN-R after hospitalization and enhances the force generating capacity as well as muscle mass gains. Skeletal muscle mass content and muscular function improvements are partially maintained for a short period of time when the exercise program ceases.

Anthropometric changes in adolescents with anorexia nervosa in response to resistance training.

PURPOSE: The follow-up of anthropometric percentiles such as triceps and mid-thigh skinfold thickness (TSF, MTSF), mid-upper arm and mid-thigh circumferences (MUAC, MTC), and arm and mid-thigh muscle areas (AMA, MTMA) after a resistance training might allow for detecting nutritional progress of fat and muscular tissue during the treatment of anorexia nervosa restricting (AN-R) type patients. METHODS: A total of 44 AN-R patients were randomized for control (CG 13.0 ± 0.6 years) and intervention (IG 12.7 ± 0.7 years) groups after hospitalization. The intervention group underwent a resistance training program of 8 weeks following the guidelines for healthy adolescents (3 days/week; 70 % of 6 RM). All measurements were obtained prior to starting the program (PRE) and after 8 weeks of training (POST) in both groups. TSF, MTSF, MUAC, and MTC were measured, and AMA and MTMA were calculated. Data were matched with percentile tables for general population. Changes were assessed using statistical tests for categorical data. RESULTS: The distribution of percentile categories within the groups did not differ statistically after 8 weeks (p > 0.05). After training, 73 % of the patients were at the same percentile interval of MUAC, 18 % higher and 9 % lower, while 30 % of CG was at lower percentile categories. Further, 54 % of the IG patients remained at the same percentile interval of MTC after training, and 36 % higher, while 20 % were at lower categories in the CG. The AMA increased (32 %) after training or remained at the same interval (59 %) in the IG, while the IG showed greater frequency of percentile decreases (45 %). CONCLUSIONS: Anthropometric measurements could be useful for assessing muscle status in AN-R patients during the treatment process. However, exact standard deviation scores should be used instead of percentile categories to increase the sensitivity to changes in TSF, MTSF, MUAC, MTC or AMA.

Resistance training enhances muscular performance in patients with anorexia nervosa: a randomized controlled trial.

OBJECTIVE: Low-intensity exercise applied in anorexia nervosa patients has been shown to have a harmless effect on body composition and to effect short-term improvements in muscular strength and agility. The aim of this study was to determine the effects of a high-intensity resistance training program designed for adolescents to improve strength and agility in anorexia nervosa restricting-type patients (AN-R). METHODS: From a total of 36 female patients with AN-R, one group (intervention, n = 18) underwent a supervised high-intensity resistance training program lasting 8 weeks, and the other group with no exercise (control, n = 18). Body weight, body mass index, whole-body muscular strength, and agility were assessed before, after, and 4 weeks after training (detraining). RESULTS: Leg-press, bench-press, and lateral row tests improved significantly (p < 0.001) after 8 weeks of training compared with controls. Improvements were maintained after the detraining period. The training program also showed beneficial effects on agility. DISCUSSION: A high-intensity resistance training program adapted to the recommendations for adolescents in AN-R patients was effective and safe, improving muscular strength in the whole body and the ability to perform daily tasks. However, long-term maintenance of gains seems to be linked to the continuance of training or the use of a maintenance program.

The second wind phenomenon in very young McArdle's patients.

We investigated the phenomenon of second wind in four patients with McArdle's disease: a brother and sister (aged 4 and 12 years respectively) and two unrelated patients, a boy of 14 and a 17-year-old girl. We also studied the siblings' healthy 6-year-old sister. Each patient performed a 15-min exercise test at a constant workload and a subsequent graded exercise test until exhaustion. Overall the healthy girl and the youngest McArdle's patient, the 4-year-old boy, did not show a second wind phenomenon. Further, the peak cardio-respiratory capacity of the young McArdle's boy was normal for his age (32.3 mL 02/kg/min) and he did not report any function limitations during physical education classes.