Sérgio G. Stella

Depression, anxiety and quality of life scores in seniors after an endurance exercise program

OBJECTIVE Mood disorders are a frequent problem in old age, and their symptoms constitute an important public health issue. These alterations affect the quality of life mainly by restricting social life. The participation in a regular exercise program is an effective way of reducing or preventing the functional decline associated with aging. The aim of the present study was to examine the effects of fitness-endurance activity (at the intensity of Ventilatory Threshold 1 (VT-1)) in depression, anxiety and quality of life scores in seniors. METHODS The study involved 46 sedentary seniors aged 60-75 (66.97 +/- 4.80) who were randomly allocated to two groups: 1) Control group, which was neither asked to vary their everyday activities nor to join a regular physical fitness program; and 2) Experimental group, whose members took part in an aerobic fitness program consisting of ergometer cycle sessions 3 times a week on alternate days for six months working at a heart rate corresponding to ventilatory threshold (VT-1) intensity. Subjects were submitted to a basal evaluation using the geriatric depression screening scale--GDS, STAI trait/state (anxiety scale) and SF-36 (quality of life scale). RESULTS Comparing the groups after the study period, we found a significant decrease in depressive and anxiety scores and an improvement in the quality of life in the experimental group, but no significant changes in the control group. CONCLUSION The data suggest that an aerobic exercise program at VT-1 intensity suffices to promote favorable modifications in depressive and anxiety scores to improve the quality of life in seniors.

Metabolic and Nutritional Profile of Obese Adolescents With Nonalcoholic Fatty Liver Disease

Background: The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program. Patients and Methods: We studied 43 adolescents ages 15 to 19 years (17.18 ± 1.66 years) with a body mass index (BMI) ≥30, consisting of 30 patients without NAFLD (BMI = 35.80 ± 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 ± 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry. Results: At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy. Conclusions: The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. The aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. In conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.

Effects of type of physical exercise and leisure activities on the depression scores of obese Brazilian adolescent girls

Several studies have indicated that depressive states may lead to hypokinesia with diminished metabolic rate and energy use. Hypokinesia associated with certain eating behaviors may lead to an unfavorable energy balance that can contribute to the emergence and prevalence of obesity among children and adults. The purpose of the present study was to examine the possibility of reducing depression inventory scores in female adolescents with third-degree obesity while testing the effectiveness of different exercise programs in reducing anxiety and depression scores. The sample consisted of 40 female subjects (mean age 16 +/- 1.56 years) divided into 4 groups (aerobic training, anaerobic training, leisure activities, and control). Subjects had a body mass index of 95% or more in relation to the 50th percentile. The aerobic program consisted of three ergometric bicycle sessions per week over a 3-month period (12 weeks) and the activities were prescribed after determining the anaerobic ventilatory threshold (VO2 threshold). Anaerobic training was based on the Wingate anaerobic power test. The leisure program consisted of a varied range of activities (games, exercises, etc.). A nutritionist interviewed the members of these two groups and the control group every week in order to adapt them to the nutritional guidelines proposed for the study. The study showed that all three programs (aerobic exercise, anaerobic exercise and leisure activities) were effective in reducing body mass. However, we found a significant reduction when analyzing the depression scores only for aerobic exercise (18.9 +/- 9.33 to 10.6 +/- 9.56 or 43.9%) but no significant alterations for anaerobic exercise (11.36 +/- 5.23 to 9.63 +/- 4.78 or 15.22%) and leisure (17.28 +/- 7.55 to 15.07 +/- 7.54 or 12.78%), thus indicating that in principle this type of activity could be included to improve emotional well-being of obese adolescent girls.

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos

O objetivo do presente estudo foi avaliar as alteracoes promovidas, por intervencao multidisciplinar, nas concentracoes plasmaticas de grelina e leptina, adiposidade visceral e prevalencia de esteatose hepatica nao alcoolica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m2) e 12 meninos (IMC 37,08 ± 3,17kg/m2), com idade entre 15 e 19 anos, quanto a concentracao de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnostico de NAFLD pelo metodo de ultra-sonografia. Os resultados demonstraram reducao significante na concentracao circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda reducao percentual na prevalencia de NAFLD, sendo este um resultado relevante, visto que esta doenca pode progredir para cirrose, tanto em criancas quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabolico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

Alterations in Downstream Mediators Involved in Central Control of Eating Behavior in Obese Adolescents Submitted to a Multidisciplinary Therapy

OBJECTIVE The aim of this study was to verify the effects of a multidisciplinary therapy (24 weeks) on neurohormonal control of food intake, specifically in orexigenic (total ghrelin, agouti-related protein [AgRP], neuropeptide Y [NPY], and melanin-concentrating hormone) and anorexigenic factors (leptin, insulin, and alpha-melanocyte stimulating hormone [α-MSH]), in obese adolescents. METHODS A total of 88 adolescents (38 boys and 50 girls), including 62 obese and 26 normal-weight, aged 15-19 years were recruited. Obese adolescents were submitted to a 24-week multidisciplinary therapy. AgRP, NPY, melanin-concentrating hormone, leptin, insulin, glucose, α-MSH, total ghrelin, and food intake were measured at three stages (at baseline, after 12 weeks, and after 24 weeks). RESULTS At baseline, obese adolescents showed hyperleptinemia (circulating leptin levels, which were, in boys and girls, 40 and 35 times higher than in normal-weight subjects, respectively). After 24 weeks, these values decreased in all obese patients. Our results showed no differences in ghrelin levels between obese and normal-weight adolescents, in both genders. However, obese boys reduced their plasma ghrelin concentration after 24 weeks of therapy (p < .05). The multidisciplinary therapy decreased NPY and AgRP values and increased α-MSH; simultaneously with these changes there was a decrease in total food intake after 24 weeks of therapy. CONCLUSIONS We can conclude that the multidisciplinary therapy was efficient to modulate neurohormonal control of food intake in obese adolescents.

Indexes of power and aerobic capacity obtained in cycle ergometry and treadmill running: comparisons between sedentary, runners, cyclists and triathletes

The objectives of this study were: a) to determine, in a cross-sectional manner, the effect of aerobic training on the peak oxygen uptake (VO2peak), the intensity at VO2peak (IVO 2peak ) and the anaerobic threshold ( AnT) during running and cycling; and b) to verify if the transference of the training effects are dependent on the analized type of exercise or physiological index. Eleven untrained males ( UN), nine endurance cyclists (EC), seven endurance runners (ER), and nine triathletes ( TR) were submitted, on separate days, to incremental tests until voluntary exhaustion on a mechanical braked cycle ergometer and on a treadmill. The values of VO 2peak (ml.kg -1 .min -1 ) obtained in running and cycle ergometer (ER = 68.8 ± 6.3 and 62.0 ± 5.0; EC = 60.5 ± 8.0 and 67.6 ± 7.6; TR = 64.5 ± 4.8 and 61.0 ± 4.1; UN = 43.5 ± 7.0 and 36.7 ± 5.6; respectively) were higher in the group that presented specific training in the modality. The UN group presented the lower values of VO2peak, regardless of the type of exercise. This same behavior was observed for the AnT (ml.kg -1 .min -1 ) determined in running and cycle ergometer (ER = 56.8 ± 6.9 and 44.8 ± 5.7; EC = 51.2 ± 5.2 and 57.6 ± 7.1; TR = 56.5 ± 5.1 and 49.0 ± 4.8; UN = 33.2 ± 4.2 and 22.6 ± 3.7; respectively). It can be concluded that the transference of the training effects seems to be only partial, independently of the index ( VO 2peak , IVO 2peak or AnT)

Multidisciplinary treatment reduces visceral adiposity tissue, leptin, ghrelin and the prevalence of non-alcoholic fat liver disease (NAFLD) in obese adolescents

O objetivo do presente estudo foi avaliar as alteracoes promovidas, por intervencao multidisciplinar, nas concentracoes plasmaticas de grelina e leptina, adiposidade visceral e prevalencia de esteatose hepatica nao alcoolica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m2) e 12 meninos (IMC 37,08 ± 3,17kg/m2), com idade entre 15 e 19 anos, quanto a concentracao de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnostico de NAFLD pelo metodo de ultra-sonografia. Os resultados demonstraram reducao significante na concentracao circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda reducao percentual na prevalencia de NAFLD, sendo este um resultado relevante, visto que esta doenca pode progredir para cirrose, tanto em criancas quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabolico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

Avaliação da composição corporal em adolescentes obesos: o uso de dois diferentes métodos

Plethysmography is an easy and quickly method for the determination of the body composition that uses the inverse relation between pressure and volume. The objective of the present study was to compare the values obtained by plethysmography and DEXA in an obese adolescents population. The sample was composed of 88 adolescents of both genders, aged between 15 and 19 years (17.01 ± 1.6 years) engaged in a multidisciplinary physical activity program. The volunteers were submitted to a body composition evaluation in distinct days in the same week, through plethysmography and DEXA. When the different methods were compared, no significant correlation between parameters common to both methods (fat free mass, fat mass (kg) and fat mass (%), r = 0.88 p < 0.05; r = 0.92 p < 0.05; r = 0.75 p < 0.05, respectively) was observed. Our data suggest that for this specific population, plethysmography may be used as an important method of body composition evaluation.RESUMO A pletismografia e um metodo rapido e facil para determinacao da composicao corporal que utiliza a relacao inversa entre pressao e volume. O objetivo do presente estudo foi o de comparar os valores obtidos com o metodo pletismografia com os valores observados com o DEXA em uma populacao de adolescentes obesos. Participaram da amostra 88 adolescentes pos-puberes de ambos os sexos, com idades entre 15 e 19 anos (17,01 ± 1,6) ingressantes de um programa de atividade fisica multidisciplinar. Os voluntarios foram submetidos a uma avaliacao da composicao corporal em dias distintos dentro da mesma semana, pelo metodo de pletismografia e outra avaliacao pelo metodo DEXA. Quando os metodos foram comparados, nao se observaram diferencas significativas entre eles; alem disso, foram observadas correlacoes significativas entre os parâmetros comuns dos dois metodos (massa magra, massa gorda (kg) e massa gorda (%), r = 0,88 p < 0,05; r = 0,92 p < 0,05; r = 0,75 p < 0,05, respectivamente). Nossos dados sugerem que, para esta populacao especifica, a pletismografia pode ser utilizada como um metodo de avaliacao da composicao corporal.

Body composition evaluation in obese adolescents: the use of two different methods

Plethysmography is an easy and quickly method for the determination of the body composition that uses the inverse relation between pressure and volume. The objective of the present study was to compare the values obtained by plethysmography and DEXA in an obese adolescents population. The sample was composed of 88 adolescents of both genders, aged between 15 and 19 years (17.01 ± 1.6 years) engaged in a multidisciplinary physical activity program. The volunteers were submitted to a body composition evaluation in distinct days in the same week, through plethysmography and DEXA. When the different methods were compared, no significant correlation between parameters common to both methods (fat free mass, fat mass (kg) and fat mass (%), r = 0.88 p < 0.05; r = 0.92 p < 0.05; r = 0.75 p < 0.05, respectively) was observed. Our data suggest that for this specific population, plethysmography may be used as an important method of body composition evaluation.RESUMO A pletismografia e um metodo rapido e facil para determinacao da composicao corporal que utiliza a relacao inversa entre pressao e volume. O objetivo do presente estudo foi o de comparar os valores obtidos com o metodo pletismografia com os valores observados com o DEXA em uma populacao de adolescentes obesos. Participaram da amostra 88 adolescentes pos-puberes de ambos os sexos, com idades entre 15 e 19 anos (17,01 ± 1,6) ingressantes de um programa de atividade fisica multidisciplinar. Os voluntarios foram submetidos a uma avaliacao da composicao corporal em dias distintos dentro da mesma semana, pelo metodo de pletismografia e outra avaliacao pelo metodo DEXA. Quando os metodos foram comparados, nao se observaram diferencas significativas entre eles; alem disso, foram observadas correlacoes significativas entre os parâmetros comuns dos dois metodos (massa magra, massa gorda (kg) e massa gorda (%), r = 0,88 p < 0,05; r = 0,92 p < 0,05; r = 0,75 p < 0,05, respectivamente). Nossos dados sugerem que, para esta populacao especifica, a pletismografia pode ser utilizada como um metodo de avaliacao da composicao corporal.