Bariatric surgery and exercise: A pilot study on postural stability in obese individuals

This study aimed to analyze the changes in postural stability of individuals with obesity after bariatric surgery, and the effect of three months of regular exercise on the static postural stability. Twenty-two subjects (7 females and 15 males) aged 31 to 68 years (Body mass index 35–55 kg.m-2) completed the study. Participants were divided into two groups: one group participated in an exercise program after the bariatric surgery (n = 10; age 48.9 ± 7.5 years; Body mass index 42 ± 5.6 kg.m-2) while the second group did not exercise at all after bariatric surgery (n = 12; age 44.7 ± 13.6 years, Body mass index 42.6 ± 6.0 kg.m-2). Static postural stability was measured using a Tekscan MobileMat pressure plate before and 4 months after the bariatric surgery. The exercise program included exercising three times a week including: one hour of strengthening, one hour of aerobic group exercise and at least one session of individual exercise at home. There were no significant differences in Center of force sway, Center of force ranges and average speed before and 4 months after bariatric surgery. Also, no effect of exercise was found. Post-pre differences of some parameters were negatively related to age (r from—0.46 to—0.72). Further studies are needed to explore this topic in depth.

Assessing the Utility of an Outpatient Exercise Program for Children With Cystic Fibrosis: A Quality Improvement Project

Children with cystic fibrosis (CF) (cwCF) suffer from inadequate weight gain, failure to thrive, and muscle weakness. The latter may be secondary to disuse atrophy (muscle wasting or reduction in muscle size associated with reduced physical activity and inflammation). Handgrip strength (HGS) is a reliable surrogate for muscle strength and lean body mass. Data from our CF center have shown an association between low HGS and forced expiratory volume in 1 s (FEV1) in cwCF. High-intensity interval training (HIIT) improves physical strength. Therefore, we devised a project to assess implementing a HIIT exercise program in the home setting, in order to improve physical strength in cwCF with HGS ≤ 50th percentile. Patients were instructed to complete 3–5 sessions of HIIT exercises per week. Wilcoxon matched-pairs signed-rank tests were used to compare HGS, FEV1, and body mass index (BMI) percentile at baseline and at a follow-up clinic visit. Follow-up was limited due to the COVID pandemic. Adherence to the HIIT regimen was poor. A total of twenty-nine cwCF participated in the program. However, a total of 13 individuals reported some form of moderate activity at follow-up and therefore constituted our final study population. There was a statistically significant increase in absolute grip strength (AGS) and FEV1 for these individuals. Even though the home HIIT protocol was not followed, the project demonstrated that moderate physical activity in cwCF can lead to significant improvement in HGS and overall physical strength.

Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Salivary Cortisol Awakening Response as a Predictor for Depression Severity in Adult Patients with a Major Depressive Episode Performing a Daily Exercise Program

<b><i>Introduction:</i></b> The hypothalamic-pituitary-adrenal axis function in depression has been the subject of considerable interest, and its function has been tested with a variety of methods. We investigated associations between saliva cortisol at awakening and the 24-h urine cortisol output, both measured at study baseline, with endpoint depression scores. <b><i>Methods:</i></b> Patients were admitted to a psychiatric inpatient ward with a major depressive episode and were started on fixed duloxetine treatment. They delivered saliva samples at awakening and 15, 30, and 60 min post-awakening and sampled urine for 24 h. Subsequently, they started a daily exercise program maintained for a 9-week period. Clinician-rated depression severity was blindly assessed with the Hamilton Depression Rating 6-item subscale (HAM-D₆). The cortisol awakening response was quantified by the area under the curve with respect to the ground (AUC_G) and with respect to the rise (AUC_I) using saliva cortisol levels in the 1-h period after awakening. Analysis of expected associations between depression severity, AUC_G, AUC_I, exercise, and 24-h cortisol output was performed in a general linear model. <b><i>Results:</i></b> In all, 35 participants delivered saliva or 24-h urine samples. The mean age was 49.0 years (SD = 11.0) with 48.6% females with a mean baseline HAM-D₆ score of 12.2 (SD = 2.3). In a statistical model investigating the association between HAM-D₆ at week 9 as a dependent variable and AUC_I, concurrent HAM-D₆, gender, smoking, and exercise volume as covariates, we found a significant effect of AUC_I, concurrent HAM-D₆, and exercise. The following statistics were found: AUC_I (regression coefficient 0.008; <i>F</i> value = 9.1; <i>p</i> = 0.007), concurrent HAM-D₆ (regression coefficient 0.70; <i>F</i> value = 8.0; <i>p</i> = 0.01), and exercise (regression coefficient −0.005; <i>F</i> value = 5.7; <i>p</i> = 0.03). The model had an <i>R</i>² of 0.43. The association between HAM-D₆ endpoint scores and the AUC_I showed that higher AUC_I values predicted higher HAM-D₆ endpoint values. The association between HAM-D₆ endpoint scores and the exercise level showed that a high exercise level was associated with lower HAM-D₆ endpoint values. <b><i>Conclusion:</i></b> The results thus showed that high AUC_I values predicted less improvement of depression and high exercise levels predicted more improvement of depression. These findings need to be confirmed in larger samples to test if more covariates can improve prediction of depression severity.

Using Sensor Graphs for Monitoring the Effect on the Performance of the OTAGO Exercise Program in Older Adults

The OTAGO exercise programme is effective in decreasing the risk for falls of older adults. This research investigated if there is an indication that the OTAGO exercise programme has a positive effect on the capacity and as well as on the performance in mobility. We used the data of the 10-months observational OTAGO pilot study with 15 (m = 1, f = 14) (pre-)frail participants aged 84.60 y (SD: 5.57 y). Motion sensors were installed in the flats of the participants and used to monitor their activity as a surrogate variable for performance. We derived a weighted directed multigraph from the physical sensor network, subtracted the weights of one day from a baseline, and used the difference in percent to quantify the change in performance. Least squares was used to compute the overall progress of the intervention (n = 9) and the control group (n = 6). In accordance with previous studies, we found indication for a positive effect of the OTAGO program on the capacity in both groups. Moreover, we found indication that the OTAGO program reduces the decline in performance of older adults in daily living. However, it is too early to conclude causalities from our findings because the data was collected during a pilot study.

The Effect of Isometric Hip External Rotation on Lower Extremity Muscles Activities During Pelvic Drop With Different Positions of the Hip Rotation in Subjects With and Without Genu Valgum: Controlled Laboratory Study

Background: Gluteus medius muscle (Gmed) dysfunction has been confirmed as a functional defect in subjects with Genu Valgum Deformity (GVD). In relation to these subjects, increase Gmed activity without synergist muscles dominance is considered as part of a specialized exercise program. Methods: A total of thirty female recreational athletes with (n=15) and without (n=15) GVD participated in this study. Surface electromyography measured Gmed, tensor fascia latae (TFL), and quadratus lumborum (QL) muscles activity when subjects performed pelvic drop (PD) in three different positions of hip rotations with and without applied isometric hip external rotation force. Results: There were differences in muscle activity between GVD and healthy subjects. The Gmed/TFL and Gmed/QL muscles activity ratio altered when placing the hip in different rotation positions and applying isometric load. Conclusions: The lower extremity muscles activity is affected by GVD, and changing the positions of the hip rotation in the PD task can be associated with altered muscle activity in both GVD and healthy Groups. However, applying isometric hip external rotation during PD can be suggested as an effective intervention to increase Gmed activity.