Different methods for monitoring intensity during water-based aerobic exercises.

The aim of this study was to compare different measurement techniques (indirect calorimetry, IC; heart rate monitoring, HR; an activity monitoring system, AH; rates of perceived exertion, RPE) to estimate physical activity intensity (light, moderate, vigorous) during water-based aerobic exercises (WE). Twelve healthy young women performed five common WE of 10-min duration at three frequencies in an indoor swimming pool. Data recorded from the 5th to 9th minute of exercise were averaged to obtain mean [Formula: see text] (IC), HR and AH values; RPE was recorded at the end of each WE. Oxygen uptake was also estimated from HR data using three different [Formula: see text] versus HR regression equation models. Significant correlations (p\ua0\ua00.7 in all cases). An ANOVA test showed no significant differences between all predicted and measured [Formula: see text] values; however, when the Bland & Altman analysis was considered, AH data showed the larger explained variances (95\% CI) and the larger standard errors. These data indicate that the most accurate way to estimate physical activity intensity during WE is based on HR measurements

Water-based training enhances both physical capacities and body composition in healthy young adult women

PURPOSE: The purpose of this study was to determine the effectiveness of a 9 weeks aquatic training program on aerobic capacity, muscle strength, flexibility, balance and body composition in 34 healthy young adult women. METHODS: Five typical water based exercises (WE) of known intensity were utilized during the classes; intensity ranged from “moderate” to “hard” according to ACSM criteria (RPE range 12–14). RESULTS: The group physical activity level and food intake were not significantly different before and after training. A significant decrease for the skin folds sum (−4.6 %) and for %fat mass (−3.8 %) calculated according to skin folds technique was found after training. DXA regional data showed a significant increase in the fat-free mass of arms (2.4 %) and trunk (0.9 %). According to the Astrand step test, the training program led to an increase of estimated maximal oxygen uptake (14.9 %) and a decrease in sub-maximal Heart Rate (−6.9 %). A significant change in the majority of the physical capacities tested was found: abdominal and upper body muscular endurance (21 and 36 %, respectively), leg flexors and extensors maximal strength (12 and 8 %, respectively) as well as balance (34 %) all improved after training (p < 0.05). CONCLUSIONS: A training program based on WE of known intensity and tailored to the ACSM recommendations can significantly improve cardio respiratory fitness, muscular endurance, strength, balance and some aspects of body composition in active young adult women

Frailty, psychological well-being, and social isolation in older adults with cognitive impairment during the SARS-CoV-2 pandemic: data from the GeroCovid initiative

Background: The containment measures linked to the COVID-19 pandemic negatively affected the phyco-physical well-being of the population, especially older adults with neurocognitive disorders (NCDs). This study aims to evaluate whether the frailty of NCD patients was associated with different changes in multiple health domains, in particular in relation to loneliness and social isolation, pre- and post-lockdown. Materials and methods: Patients were recruited from 10 Italian Centers for Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period (T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL (IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were administered. Caregivers' burden was also tested. Patients were categorized as non-frail, pre-frail, and frail according to the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale. Results: The sample included 165 subjects (61.9% women, mean age 79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores significantly declined between T0 and T2. There were no significative variations in functional and cognitive domains between the frail groups. During lockdown we recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale scores in frail people. In multivariable logistic regression, frailty was associated with an increase in social isolation, and a loss of IADL. Conclusions: We observed a global deterioration in functional and neuro-psychiatric domains irrespective of the degree of frailty. Frailty was associated with the worsening of social isolation during lockdown. Frail patients and their caregivers seemed to experience more anxiety and stress disorders during SARS-CoV-2 pandemic

Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing Enterobacterales Infections: A Multicenter Nationwide Clinical Experience (CEFTABUSE II Study)

Background. Few data are reported in the literature about the outcome of patients with severe extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy.Methods. A multicenter retrospective study was performed in Italy (June 2016-June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy.Results. C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index &gt;4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8-7.9; P &lt; .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9-5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01-0.34; P &lt; .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14-0.55; P &lt; .001) were associated with clinical success.Conclusions. Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT

Analysis of the Energy Expenditure of Water–Based Activities and of their effects on physical capacities and body composition after training

INTRODUZIONE La ricerca scientifica ha da anni dimostrato che, tra pratica regolare di esercizio fisico e salute, esiste una relazione particolarmente significativa (Pate et al., 1995; US Department of Health and Human Service, 1996; Haskell et al., 2007). In particolare, alcune componenti della physical fitness (capacità aerobica, forza e resistenza muscolare, flessibilità, equilibrio ed una corretta composizione corporea) sembrano avere un ruolo chiave per il mantenimento della salute e dell’autonomia funzionale. Per tale ragione ed in funzione della specificità della risposta fisica agli stimoli allenanti, le più accreditate linee guida per la prescrizione dell’esercizio fisico (ACSM 1998, 2009) considerano competo (“well rounded”) quel training capace di indurre miglioramenti di tutte queste capacità fisiche includendo esercizi di resistenza cardiovascolare, forza, flessibilità ed equilibrio. Esse sottolineano inoltre che la selezione di un’appropriata attività fisica (in termini di tipologia, intensità, frequenza e durata), è presupposto fondamentale all’ottenimento di reali adattamenti organici, alla prevenzione degli infortuni ed all’aumento di aderenza ai protocolli di lavoro. Le attività di fitness acquatico (WA) hanno guadagnato negli ultimi dieci anni una straordinaria popolarità e rappresentano una delle possibili alternative tra le attività fisiche tradizionalmente dedicate al benessere ed alla salute. Ad oggi sono praticate da un numero sempre crescente di persone e da tipologie di individui dalle caratteristiche estremamente eterogenee (soggetti giovani ed anziani, individui sani ma anche affetti da patologie o limitazioni funzionali temporanee e/o permanenti, atleti in fase di recupero post-infortunio o in buona salute). Anche se, in letteratura, gli adattamenti organici (cronici ed acuti) a questa tipologia di esercizio fisico sono stati ampiamente discussi (e.g. Campbell et al., 2003; Takeshima et al., 2002; Colado et al., 2008; Colado et al., 2009 a and b; Barbosa et al., 2009), la valutazione dell’intensità d’esercizio in ambiente acquatico costituisce ancora un problema e questo è particolarmente evidente quando le attività fisiche considerate si presentano complesse da un punto di vista tecnico e/o quando si tenta di definire l’intensità in condizioni non rigidamente controllate. Ad oggi, le conoscenze e gli strumenti necessari a definire con precisione l’intensità d’esercizio, a pianificare un programma adatto a soggetti dalle caratteristiche diverse ed a monitorare i risultati di un training di fitness acquatico, non risultano sufficienti. SCOPI Il presente lavoro si pone l’obiettivo di definire più precisamente il ruolo che le attività di fitness acquatico possono rivestire per il benessere e la salute delle persone e di capire se, questa tipologia di esercizio fisico, può costituire un allenamento completo (“well rounded”) in riferimento ai requisiti proposti dall’ American College of Sport Medicine. La tesi include tre studi. •Il primo studio si è occupato di quantificare l’intensità (EI) dei più comuni esercizi di fitness acquatico (WE) eseguiti a tre differenti frequenze di movimento (f1 = 1.8-2.0 Hz; f2 = 2.0-2.2 Hz; f3 = 2.2-2.4 Hz) ed ad ampiezza standardizzata e controllata. Successivamente è stata quantificata l’intensità di una combinazione di questi esercizi eseguiti a data frequenza. •Il secondo studio si è occupato di programmare un WE training di intensità nota e della durata di nove settimane e di verificarne l’efficacia sulle componenti della physical fitness (capacità aerobica, forza e resistenza muscolare, flessibilità, equilibrio ed una corretta composizione corporea) maggiormente correlate alla salute. •Il terzo studio si è occupato di confrontare differenti tecniche di misura e di stima dell’intensità di esercizio durante fitness acquatico. STRUTTURA DELLA TESI La tesi si presenta divisa in quattro capitoli. Il primo capitolo comprende: un’introduzione generale al lavoro (sezione 1.1), una sintesi delle principali caratteristiche dell’ambiente acquatico (sezione 1.2) e la presentazione dei più importanti adattamenti fisiologici dell’organismo umano all’immersione in atteggiamento verticale (sezione 1.3). Successivamente vengono descritte (sezione 1.4) e classificate (sezione 1.5) le più comuni attività di fitness acquatico e viene presentata la letteratura specificatamente dedicata a questa tipologia di esercizio fisico (sezione 1.6). I metodi utili a misurare e/o stimare l’intensità dell’esercizio fisico sono discussi in generale nella sezione 1.7 ed in relazione alle attività di fitness acquatico nella sezione 1.8. In ultimo sono schematicamente riassunti i principali obiettivi dello studio (sezione 1.9). Il secondo capitolo è dedicato all’introduzione (sezione 2.1) del primo studio (“Exercise Intensity of head-out water based activities (water fitness)”), ai materiali e metodi utilizzati durante il lavoro (sezione 2.2), ai risultati ottenuti (sezione 2.3) ed alla loro discussione (sezione 2.4 e sezione 2.5). Il terzo capitolo è dedicato all’introduzione (sezione 3.1) del secondo studio (“Water-based training enhance both physical capacities and body composition in healthy young adult women”), ai materiali e metodi utilizzati durante il lavoro (sezione 3.2), ai risultati ottenuti (sezione 3.3) ed alla loro discussione (sezione 3.4 e sezione 3.5). Il quarto capitolo è dedicato all’introduzione (sezione 4.1) del terzo studio (“Monitoring intensity during water based activities (head-out immersion): a comparison among different measurement techniques”), ai materiali e metodi utilizzati durante il lavoro (sezione 4.2), ai risultati ottenuti (sezione 4.3) ed alla loro discussione (sezione 4.4 e sezione 4.5). Al termine della tesi è compresa una discussione generale dei risultati ottenuti dagli studi precedentemente descritti ed una definizione del ruolo che le attività di fitness acquatico possono rivestire per il benessere ed il mantenimento della salute in linea con lo scopo generale del lavoro.BACKGROUND A strong relationship between regular physical activity and health has been clearly established (Pate et al., 1995; US Department of Health and Human Service, 1996; Haskell et al., 2007). Particularly, some components of physical fitness such as cardiovascular endurance, muscular strength and endurance, flexibility, balance and a correct body composition seem to be strong health-related variables. The guidelines of the American College of Sport Medicine (1998; 2009) place a strong emphasis on these components of physical fitness and underline that, given the specific nature of exercise adaptation, a “well rounded” training program should consist of aerobic, resistance and flexibility exercises. The existing evidence concerning exercise prescription also underlines that the selection of an appropriate physical activity (in terms of exercise mode, intensity, frequency and duration) is essential in order to obtain actual training effects, to avoid injuries and to ensure exercise adherence. Water based activities (WA), in recent years, gained popularity and are considered as one of the possible alternatives among the traditional physical activities for well-being and health. These activities are performed by different types of subjects: young and adult healthy individuals who regularly take part in recreational training but also individuals with low levels of physical fitness (such us elderly people, subjects with orthopaedic or neurological disabilities, athletes with surgically, or otherwise, treated injuries and obese persons). Even if the physiological responses and training effects of WA have been investigated by several authors in different populations (e.g. Campbell et al., 2003; Takeshima et al., 2002; Colado et al., 2008; Colado et al., 2009 a and b; Barbosa et al., 2009), the accurate assessment of intensity during “water exercises” performed without specific equipment is not a simple task, expecially in a field setting, during water based classes. Thus, at present, there are still no sufficient tools to define the work intensity, to plan a training program adapted to different subjects and to monitor and verify the training effects of WA. AIM The aim of this doctoral Thesis is therefore to better define the role of water based activities for public health and to better understand whether these physical activities can be considered a “well rounded” training program according to the American College of Sport Medicine recommendations. The present work includes three studies. •The aim of the first study was to make a further step in the comprehension of the exercise intensity (EI) during water based activities by: i) measuring the exercise intensity of the most common water based exercises (WE) at different movement frequencies (f1 = 1.8-2.0 Hz; f2 = 2.0-2.2 Hz; f3 = 2.2-2.4 Hz) and at a standardize movement’s amplitude; ii) measuring EI during a combination (MIX) of these WE. •The aim of the second study was to determine the effectiveness of a nine weeks aquatic training program of known intensity (EI) on aerobic capacity, muscle strength, flexibility, balance and body composition, in healthy young adult women. •The aim of the third study was to compare different measurement techniques to estimate physical activity intensity during water based activity. STRUCTURE OF THE THESIS This Thesis is divided in four chapters. The first chapters includes a general introduction to the problem (section 1.1), a brief summary of the aquatic environment characteristics (section 1.2) and a section dedicated to the more important physiological adjustment to head-out immersion (section 1.3). In this first part of Thesis, the water based activities are also presented (section 1.4) and classified (section 1.5) in order to better define the characteristics of the water fitness exercises. The related scientific background is thus reviewed and discussed (section 1.6). Finally, the assessment of exercise intensity is discussed in general terms (section 1.7) as well as in regard to the physical activity performed in water (section 1.8). At the and of this chapter, the main aims of the three studies are schematically reported (section 1.9). In the second chapter, the study entitled “Exercise Intensity of head-out water based activities (water fitness)” is presented. After a brief introduction (section 2.1), the materials and methods (section 2.2) are explained in detail and the results are illustrated (sections 2.3). Finally, the results are discussed (section 2.4 and 2.5). In the third chapter, the study entitled “Water-based training enhance both physical capacities and body composition in healthy young adult women” is presented. After a brief introduction (section 3.1), the materials and methods (section 3.2) are explained in detail and the results are illustrated (sections 3.3). Finally the results are discussed (section 3.4 and 3.5). In the fourth chapter, the study entitled “Monitoring intensity during water based activities (head-out immersion): a comparison among different measurement techniques” is presented. After a brief introduction (section 4.1), the materials and methods (section 4.2) are explained in detail and the results are illustrated (sections 4.3). Finally the results are discussed (section 4.4 and 4.5). At the end of this Thesis, a general discussion of the results obtained in the three studies is reported to better define the role of water based activities for public health and to better understand whether these physical activities can be considered a “well rounded” training program (according to American College of Sport Medicine recommendations), in line with the main aim of this work

Financial Cooperatives: between local communities and global forces

This paper explores the role of co-operative finance in the evolution of financialization of the global economy building upon the Italian context. Whereas financialization of daily life has globally affected many individuals around the world in the last decades (Martin, 2002), this has also re-shaped the role of financial institutions in society. Earlier research has suggested that private banks have shifted from providing intermediary services between savers and lenders, towards investing in short term investments and preferring liquidity (Mehrling, 2010). Economists suggest that as a consequence of this, the main social relation of the economy –between debtor and creditor– has been torn apart (Amato and Fantacci, 2014). In turn, anthropological studies have added more nuance, bringing to the forefront the fact that credit/debt relationship generates social bonds even in a context dominated by the market ideology that pretends to be apolitical or neutral (Graeber, 2011). Thus, social bonds take a more disaggregated shape and now include new middle men that trade other’s debt under the form of derivatives (Zaloom, 2010).Drawing on this, we turn to the Italian co-operative financial sector and its capacity to (re)establish social relations through practices that counteract this global trend. Employing ethnographic methodology, we highlight three practices that are instrumental –although imperfect– in bringing creditor-debtor social relation back to the centre of the economy, namely: prioritizing classical banking activity (savings and lending), humanising credit risk, and promoting financial education

Exercise intensity of head-out water based activities (water fitness).

The aims of this study were: i) to measure the exercise intensity EI) of the most common water based exercises (WE) at different movement frequencies (f1 = 1.8-2.0 Hz; f2 = 2.0-2.2 Hz; f3 = 2.2-2.4 Hz) and at a standardized amplitude; ii) to measure EI during a combination of these WE. Five WE were selected: "running raising the knees high " (S); "jumping moving the legs sideways" (SJ); "jumping moving the legs backward and forward" (FJ); "alternate forward kicks" (FK); "alternate sideways kicks" (SK). Twelve physically active women were asked to perform these WE at the three frequencies, as well as a combination (MIX)f the WE. EI increased significantly (p &lt; 0.01) with increasing frequency; as an average, for all WE: VO2 ranged from 18 to 25 ml . kg-1 . min-1, HR from 102 to 138 bpm, RPE from 9.8 to 14.4 (at f1 and f3, respectively). In terms of % VO2max, EI ranged from 37 to 54% for S, was similar for SJ and FJ (31 - 43%) and for FK and SK (47 - 63%) at f1 and f3, respectively. Thus, a given EI can be attained either by changing the type of exercise and/or the frequency of the movement. The combination of exercises did not change (in terms of VO2, HR and RPE) the intensity of each exercise performed separately. These data can be utilized to control, in terms of exercise type and frequency, the intensity of a proposed water based activity

Monitoring intensity during head-out water based activities (water fitness): a comparison among different measurement techniques

The aim of this study was to compare different measurement techniques (indirect calorimetry, IC; heart rate monitoring, HR; Actiheart, AH, an activity monitoring system; rates of perceived exertion, RPE) to estimate physical activity intensity (PAI) during water based exercises (WE). Twelve young active women performed five different WE at three different movement frequencies (15 trials) in an indoor swimming pool (Raffaelli et al., 2010). During the trials the subjects were monitored with: a portable metabolic system (K4b2, Cosmed, I), a heart rate monitor (T31, Polar, Fi), the Actiheart (Cambridge Neurotechnology, UK) and the Borg Scale. Each trial lasted 10 min, with a 5 min rest in between; the data recorded at steady state (5 - 9th min) were averaged to obtain mean VO2, HR and AH values. Finally, VO2 was also estimated from HR data using three different HR/VO2 regression equation models (ACSM, 1998; Brown al., 1998; Raffaelli et al., 2010). The values obtained by means of AH, HR and RPE were all significantly related with data of IC (p0.8 in all cases). The ANOVA test showed a non significant difference between all predicted and measured VO2 values. When the Bland&Altman analysis was considered, the Actiheart values showed the larger explained variances (95% CI) and the larger standard errors. In conclusion, even if all the analyzed methods are able to detect changes of intensity during WE and are significantly correlated with IC data, the more accurate way to estimate PAI during WE is still based on HR measurements. REFERENCES ACSM (1998) Med Sci Sports Exerc 30: 975-991 Brown al. (1998) Journal of Aging and Physical Activity 6: 248-255 Raffaelli et al. (2010) Eur J Appl Physiol DOI: 10.1007/s00421-010 1419-