Neuromusculoskeletal health in pediatric obesity: incorporating evidence into clinical examination

Purpose of review: The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice. Recent findings: A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.</p

Energy consumption (KJ) distribution between meals for each experimental session (SED: sedentary; LIE: Low-Intensity Exercise; HIE: High-Intensity exercise).

<p>Breakfast on day 1 (BF1) was calibrated; lunch, dinner and BF2 (breakfast on day 2) were offered <i>ad libitum</i> (adlib). *p<0.05; **p<0.01.</p

Anthropometric characteristics of the adolescents (n = 15).

<p>Data expressed as mean ± standard deviations; BMI: Body Mass Index; WC: Waist Circumference.</p

Energy intake (EI), energy expenditure (EE) and energy balance (EB) in response to sedentary (SED), low-intensity (LIE) or high-intensity (HIE) exercise sessions in obese adolescents (n = 15).

<p>Measurements were performed over 24 hours, beginning at 08:00am.</p><p>Data expressed as mean ± standard deviations. Significantly different from SED and LIE:</p><p>*p<0.05;</p><p>**p<0.01.</p

Subjective satiety feeling (Visual Analogue Scale of 100 mm) throughout the experimental sessions (SED: Sedentary; LIE: Low-Intensity Exercise; HIE: High-Intensity Exercise).

<p>BF1: calibrated breakfast on day 1; BF2: <i>ad libitum</i> breakfast on day 2.</p

A new equation based on the 6-min walking test to predict VO_2peak in women with obesity

<p><b>Objective:</b> The 6-min walking test (6 MWT) is commonly used to assess obese patients’ aerobic fitness, but it has rarely been compared with a direct measurement of maximal aerobic capacities (VO_2max or VO_2peak) in obese adults. The aim of this study was to investigate the relationship between the distance covered during a 6 MWT with objectively measured VO_2peak and to propose a new equation to predict VO_2peak from this walking test in obese patients.</p> <p><b>Methods:</b> One hundred and thirty-seven obese patients (45.6 ± 12.5 years) admitted to our hospital for a multidisciplinary rehabilitation program were enrolled. After assessment of their body composition, the participants were asked to perform a 6 MWT and their maximal aerobic capacities (VO_2peak) were measured.</p> <p><b>Result:</b> There is a significant linear relation between VO_2peak and the distance covered during the 6 MWT (<i>p</i> < 0.001; <i>r</i> = 0.349). The determinant of VO_2peak was body mass index, waist-to-hip ratio, fat free mass, leading to the follow prediction equation VO_2peak such as VO_2peak (l/min) = (body mass index ×0.0150065) − (waist-to-hip-ratio × 0.8595088) + (fat-free-mass × 0.0295478) + (6-min walk test ×0.0020672) − 0.5853372.</p> <p><b>Conclusion:</b> The 6-min walk test is a reliable method to reflect obese women’s aerobic capacities and the distance covered can be used to accurately estimate VO_2peak according to our newly proposed equation.</p> <p>Implication for rehabilitation</p><p>Obesity is a worldwide disease and physical capacity evaluation is a key point for rehabilitation.</p><p>The six minutes’ walk test is commonly used in obese people to assess aerobic fitness.</p><p>This study proposes a new equation using 6 MWT performance to estimate VO_2peak.</p><p></p> <p>Obesity is a worldwide disease and physical capacity evaluation is a key point for rehabilitation.</p> <p>The six minutes’ walk test is commonly used in obese people to assess aerobic fitness.</p> <p>This study proposes a new equation using 6 MWT performance to estimate VO_2peak.</p

Cardiovascular risk of adipokines: a review

Over the last two decades, the understanding of adipose tissue has undergone radical change. The perception has evolved from an inert energy storage tissue to that of an active endocrine organ. Adipose tissue releases a cluster of active molecules named adipokines. The severity of obesity-related diseases does not necessarily correlate with the extent of body fat accumulation but is closely related to body fat distribution, particularly to visceral localization. There is a distinction between the metabolic function of central obesity (visceral abdominal) and peripheral obesity (subcutaneous) in the production of adipokines. Visceral fat accumulation, linked with levels of some adipokines, induces chronic inflammation and metabolic disorders, including glucose intolerance, hyperlipidaemia, and arterial hypertension. Together, these conditions contribute to a diagnosis of metabolic syndrome, directly associated with the onset of cardiovascular disease. If it is well known that adipokines contribute to the inflammatory profile and appetite regulation, this review is novel in synthesising the current state of knowledge of the role of visceral adipose tissue and its secretion of adipokines in cardiovascular risk

Challenges of considering both extremities of the weight status spectrum to better understand obesity: Insights from the NUTRILEAN Project in Constitutionally Thin Individuals

While the physiology of obesity has been so extensively investigated to date, only an extremely small number of studies (less than 50) have focused on the other extremity of the weight spectrum: constitutional thinness. Yet, this important state of underweight in the absence of any eating disorders provides a mirror model of obesity that might be particularly insightful in understanding obesity. Nevertheless, important methodological and recruitment-related issues appear when it comes to this complex constitutionally thin phenotype, as experienced by our research group with the realization of the ongoing NUTRILEAN clinical trial. To face this challenge, the present paper aims at identifying, analysing, and discussing the quality of such recruitment processes in publications about constitutional thinness. In this order, a group of experts collectively created a new grading system to assess the level of rigor and quality achieved by each study based on different criteria. The main results were that (i) metabolic-related biasing criteria were poorly observed despite being crucial, (ii) recruitment processes were not detailed enough and with sufficient explicitness, and (iii) recruiting among already identified patients would be associated with both higher sample sizes and better scores of quality. The present work encourages investigators to adopt a high level of rigor despite the complexity and duration of recruitment processes for this specific population, and readers to pay close attention to the quality of recruitment when interpreting the data. To better understand obesity and its physiological adaptations, it seems essential not only to compare it to normal-weight conditions, but also to the other extremity of the weight status spectrum represented by constitutional thinness.</p

Is the SPARTACUS 15-15 test an accurate proxy for the assessment and tracking of maximal aerobic capacities in adolescents with obesity?

Purpose: While there is a need for reliable field tests for the evaluation of physical fitness in pediatric obesity, the present work i) evaluates the validity of the Spartacus 15-15 test in indirectly assessing maximal aerobic capacity in adolescents with obesity and ii) evaluates its sensibility to weight loss.  Participants and Methods: Fifty-five 11-16 year-old adolescents with obesity (Tanner 3-4) were enrolled in a 12-week weight-management intervention. Maximal Aerobic fitness (VO2peak test + Spartacus test) and body composition (Dual X-ray absorptiometry) were assessed at baseline and after 12 weeks.  Results: Moderate correlations were found at baseline between VO2peak (2,231.90 ± 465.6 mL/min) and Spartacus stage (6.83 ± 1.8 stage, r=0.52; p≤0.05), speed (12.85 ± 1.8 km/h, r=0.52 ; p≤0.05) and time (20.6 ± 5.4 min; r=0.50; p≤0.05). The intervention favored significant improvements for VO2peak, Spartacus Rate of Perceived Exertion final stage, maximal speed and time. Change over time in VO2peak and Spartacus variables were not correlated.  Conclusion: The Spartacus test can be used as a proxy for VO2peak at baseline and can be used to estimate VO2peak using the proposed equation. The Spartacus 15-15 test might be a better indicator for changes in functional capacity than an indicator of VO2peak changes in youth with obesity.</p

Association between active video games and learning and rehabilitation in children and youth.

<p>Association between active video games and learning and rehabilitation in children and youth.</p