Marisa Arpesella

Improved metabolic and cardiorespiratory fitness during a recreational training program in obese children

Abstract Physical activity may protect from the adverse effects of obesity. In obese children, an increased adherence and a decreased drop-out rate during exercise could be achieved with adaptated activities. We studied a recreational 12-week controlled training program for sedentary obese children, including interactive video games. We enrolled 22 obese subjects (13.23±1.76 years) in an exercise program, implemented twice a week for a 12-week period. The program consisted of a combination of circuit-based aerobics, strength and resistance exercises; specifically soccer, rugby, volleyball and basketball and interactive video game exercises. Outcome measurements included body composition, metabolic profile and cardiorespiratory fitness. During the 12-week training program there was a significant decrease in body mass index (BMI) (p=0.002), SDS-BMI (p=0.003), waist circumference (p=0.004), waist circumference/height ratio (p=0.001),% fat mass (p=0.001), blood glucose (p=0.001), homeostasis model assessment for insulin resistance (HOMA-IR) (p=0.04), triglycerides (p=0.03) and systolic pressure (p=0.04) before and after exercise. Improvement in estimated maximum oxygen consumption (VO2max) (p<0.001) correlated with a decrease in fat mass (p=0.01), triglycerides (p=0.04) and insulin resistance (p=0.02). Exercise improved metabolic and cardiorespiratory fitness in obese children. Exercise training does not necessarily need to be vigorous, recreational programs are also effective and may encourage children to participate in physical activity and limit initial drop-out.

Athleticogenomics and elite athletes: a review of the state of the art and a possible relationship with inflammatory response

Background : Recent research in athleticogenomics has begun to reveal how particular genetic polymorphisms may influence athletic status and confer an individual predisposition for better sports performances. This is of particular interest for elite athletes because it could help to assess an athlete’s potential, to enhance specific training protocols for selected performances, to monitor the individual response to training load and recovery and, finally, aid in the prevention of accidents. Methods : Using a topics search in the PubMed database, the search strategy included studies examining the relationship between the presence of polymorphisms in genes influencing selected physiological parameters and the elite athletic status. English written case (elite athletes) -control (general population) studies were selected. Results : 26 research articles concerning polymorphic genes involved in muscle physiology, cell respiratory function, substrate supply and inflammatory response, significantly associated with a predisposition of elite athletes for sports respect to their control counterparts were registered. The majority of the included genes are functionally linked but the gene involved in inflammatory responses and represents the first evidence of an association between this gene polymorphism and elite athletic status. Conclusions : The identification of these polymorphisms could be potentially useful to evaluate an individual’s potential for elite sports disciplines. Moreover, as recently observed for the interleukin-1 receptor antagonist (IL-1RN) polymorphism, since there are genetic variants having a relevant role not only in sports medicine, but also in the development of medical disorders, their study could help to better understand how a particular polymorphism could influence the pathogenesis of a specific gene related disease.

European cardiovascular mortality over the last three decades: Evaluation of time trends, forecasts for 2016

BACKGROUND The circulatory diseases, in particular ischemic heart diseases and stroke, represent the main causes of death worldwide both in high income and in middle and low income countries. Our aim is to provide a comprehensive report to depict the circulatory disease mortality in Europe over the last 30 years and to address the sources of heterogeneity among different countries. METHODS Our study was performed using the WHO statistical information system - mortality database - and was restricted to the 28 countries belonging to the European Union (EU-28). We evaluated gender and age time series of all circulatory disease mortality, ischemic heart diseases, cerebrovascular diseases, pulmonary and other circulatory diseases and than we performed forecast for 2016. Mortality heterogeneity was evaluated by countries using the Cochrane Q statistic and the I-squared index. RESULTS Between 1985 and 2011 SDR for deaths attributable to all circulatory system diseases decreased from 440.9 to 212.0 x 100,000 in EU-28 and a clear uniform reduction was observed. Heterogeneity among countries was found to be consistent, therefore different analysis were carried out considering geographical area. CONCLUSIONS We forecast a reduction in European cardiovascular mortality. Heterogeneity among countries could only in part be explained by both geographical and health expenditure factors.

Deep breathing improves blunted baroreflex sensitivity in obese children and adolescents with insulin resistance.

adolescents with insulin resistance V. Calcaterra , M. Vandoni , G. Debarbieri , D. Larizza , R. Albertini , M. Arpesella , L. Bernardi c,e,⁎ a Department of Internal Medicine University of Pavia and Department of Pediatrics, IRCCS Policlinico San Matteo Foundation Pavia, Italy b Department of Applied Health Sciences and Neurosciences, University of Pavia, Italy c Department of Internal Medicine University of Pavia and IRCCS Policlinico San Matteo Foundation Pavia, Italy d Laboratory of Clinical Chemistry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy e Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Finland

Benchmarking of health technologies distribution models: An investigation of Lombardy’s local health authorities

Purpose – The purpose of this paper is to develop a benchmarking framework for assessing the performance of the distribution models adopted by the local branches of National Health Services (NHSs) for delivering health technologies to patients at a local level, and to derive prescriptions for enhancing design and optimal management of the distribution models. Design/methodology/approach – The authors focussed the study on the distribution of absorbent devices for incontinence, adopting the analytic hierarchy process as a tool for developing the benchmarking framework. The authors applied the framework to the context of the Italian NHS with respect to the Lombard Local Health Authorities, assessing their performance in terms of operational efficiency and service quality. Findings – The developed framework constitutes a novel contribution, and it allows for generating prescriptions. Through its application to the context studied the authors found that a “one-size-fits-all” distribution model cannot be propo...

Deep breathing acutely improves arterial dysfunction in obese children: Evidence of functional impairment?

BACKGROUND AND AIMS Similarly to diabetes type 2, patients with obesity show insulin resistance and autonomic and vascular abnormalities associated with increased morbidity and mortality. We tested whether arterial dysfunction in obese children may have a functional nature, reversible with appropriate interventions (e.g., by reduction of sympathetic activity), or else results from anatomic arterial modifications (likely irreversible). For this purpose, we tested whether deep breathing (an intervention known to transiently reduce sympathetic activity) could acutely improve arterial function, hence showing a functional abnormality. METHODS AND RESULTS A total of 130 obese children and 67 age-matched healthy normal-weight control children were recruited. Arterial function was measured by augmentation index (AIx), by direct analysis of blood pressure contour, and by pulse wave velocity (PWV), during spontaneous and controlled breathing. The markers of metabolic syndrome were evaluated at baseline. AIx showed increased values in obese male participants as compared with the control group. Slow breathing acutely reduced Aix in obese children, to a greater extent than in normal-weight control children. Similarly, the blood pressure contour showed higher values in obese children that were significantly attenuated by slow breathing. Baseline PWV was not altered in obese participants. The markers of metabolic syndrome correlated with AIx and PWV. CONCLUSIONS Obese subjects showed impaired arterial function. The acute improvement in vascular abnormalities with reduction in sympathetic activity indicates that this alteration was largely functional, likely related to initial autonomic dysfunction and to metabolic abnormalities. As a consequence, this study provides a rationale for strategies aiming at preventing arterial function deterioration in the early ages.

Hygienic and sanitary requirements of gyms in force in Italy: national issues and analysis of regional regulations.

In recent years, the awareness of the importance of physical activity for human health is growing, as people practicing it; the number of gyms has also substantially increased. Currently, in Italy there is not a consistent regulation regarding hygienic and sanitary requirements of gyms. Several Italian regions issued laws about this topic. The authors analyse the standards required by the Italian Olympic Committee (CONI) and the regional laws, highlighting the numerous issues, among which the possible location of gyms in semi-basements and basements. They eventually call for a national regulation that should clearly transpose the hygienic and sanitary requirements of gyms into a satisfactory rule of law.