Stefano Lazzer

The energetic and cardiovascular response to treadmill walking and cycle ergometer exercise in obese women

Physical activity is essential in obesity management, but exercise capacity is compromised in obese individuals due to the excessive body mass, impacting on body movement’s energetics, and to the dysfunctions of regulatory mechanisms, affecting cardiovascular responses. This study aims to compare the energetics and cardiovascular responses of walking and cycling in obese women, and to formulate recommendations regarding the most suitable type of exercise for obesity. Fifteen obese (OB) and six normal weight (NW) women exercised on treadmill (TM) and cycle ergometer (CE). During both exercise modalities, metabolic rate was higher in OB than in NW and correlated with measures of body mass. Leg movement metabolic rate during cycling depended upon individual adiposity, and when accounted for, mechanical efficiency was similar in the two groups. When accounting for extra mass, differences in metabolic rate among groups are abolished for CE, indicating no obesity impairment of muscle efficiency, but not for TM, suggesting that differences in biomechanics may explain the higher net cost of transport of OB. In both groups, HR was higher during CE than TM at the same oxygen uptake (VO2), but in OB the HR increment over VO2 was greater for CE than for TM. Therefore, due to different cardiovascular responses to TM and CE in OB, walking is more convenient, enabling OB to attain target energy expenditure at lower HR or in a shorter time.

Comparison of dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis for the assessment of body composition in severely obese Caucasian children and adolescents

The objectives of the present study were to compare body composition assessed by dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP) and bioelectrical impedance analysis (BIA) in severely obese Caucasian children and adolescents and to develop and validate new equations for predicting body composition from BIA using DXA as the reference method. Body composition was assessed in fifty-eight obese children and adolescents (BMI 34.4 (SD 4.9) kg/m(2)) aged 10-17 years by DXA, ADP and BIA. ADP body fat content was estimated from body density using equations devised by Siri (ADP(Siri)) and Lohman (ADP(Lohman)). In the whole sample, the Bland-Altman test showed that ADP(Siri) and ADP(Lohman) underestimated percentage fat mass (%FM) by 2.1 (SD 3.4) and by 3.8 (SD 3.3) percent units (P<0.001), respectively, compared to DXA. In addition, compared to DXA, BIA underestimated %FM by 5.8 (SD 4.6) percent units in the whole group (P<0.001). A new prediction equation (FFM (kg) = 0.87 x (stature(2)/body impedance) + 3.1) was developed on the pooled sample and cross-validated on an external group of sixty-one obese children and adolescents. The difference between predicted and measured FFM in the external group was -1.6 (SD 2.9) kg (P<0.001) and FFM was predicted accurately (error < 5%) in 75% of subjects. In conclusion, DXA, ADP and the BIA are not interchangeable for the assessment of %FM in severely obese children and adolescents. The new prediction equation offers an alternative approach to DXA for the estimation of body composition in severely obese children and adolescents.

Relationship between basal metabolic rate, gender, age, and body composition in 8,780 white obese subjects.

The objective of the present study was to explore the relationship between basal metabolic rate (BMR), gender, age, anthropometric characteristics, and body composition in severely obese white subjects. In total, 1,412 obese white children and adolescents (BMI > 97° percentile for gender and age) and 7,368 obese adults (BMI > 30 kg/m2) from 7 to 74 years were enrolled in this study. BMR was measured using an indirect calorimeter equipped with a canopy and fat free mass (FFM) were obtained using tetrapolar bioelectrical impedance analysis (BIA). Using analysis of covariance, we tested the effect of gender on the relationship between BMR, age, anthropometry, and body composition. In children and adolescents, the predictor × gender interaction was significant in all cases except for FFM × gender. In adults, all predictor × gender interactions were significant. A prediction equation based on body weight (BW), age, and gender had virtually the same accuracy of the one based on FFM, age, and gender to predict BMR in both children and adults (R2adj = 0.59 and 0.60, respectively). In conclusion, gender was a significant determinant of BMR in children and adolescents but not in adults. Our results support the hypothesis that the age‐related decline in BMR is due to a reduction in FFM. Finally, anthropometric predictors of BMR are as accurate as body composition estimated by BIA.

Gas exchange kinetics in obese adolescents. Inferences on exercise tolerance and prescription

A functional evaluation of skeletal muscle oxidative metabolism was performed in a group of obese adolescents (OB). The various components of pulmonary O(2) uptake (Vo(2)) kinetics were evaluated during 10-min constant-load exercises (CLE) on a cycloergometer at different percentages of Vo(2max). The relationships of these components with the gas exchange threshold (GET) were determined. Fourteen male OB [age 16.5 ± 1.0 (SD) yr, body mass index 34.5 ± 3.1 kg·m(-2)] and 13 normal-weight, age-matched nonathletic male volunteers (control group) were studied. The time-constant (τf) of the fundamental component and the presence, pattern, and relative amplitude of the slow component of Vo(2) kinetics were determined at 40, 60, and 80% of Vo(2max), previously estimated during an incremental test. Vo(2max) (l/min) was similar in the two groups. GET was lower in OB (55.7 ± 6.7% of Vo(2max)) than in control (65.1 ± 5.2%) groups. The τf was higher in OB subjects, indicating a slower fundamental component. At CLE 60% (above GET in OB subjects, below GET in control subjects) a slow component was observed in nine out of fourteen OB subjects, but none in the control group. All subjects developed a slow component at CLE 80% (above GET in both OB and control). Twelve OB subjects did not complete the 10-min CLE 80% due to voluntary exhaustion. In nine OB subjects, the slow component was characterized by a linear increase in Vo(2) as a function of time. The slope of this increase was inversely related to the time to exhaustion. The above findings should negatively affect exercise tolerance in obese adolescents and suggest an impairment of skeletal muscle oxidative metabolism. Also in obese adolescents, exercise evaluation and prescription at submaximal loads should be done with respect to GET and not at a given percentage of Vo(2max).

Optimizing fat oxidation through exercise in severely obese Caucasian adolescents

Objective  To measure the contribution of substrate oxidation to energy expenditure during cycling at different workloads and to identify the exercise intensity that elicits the maximum fat oxidation rate in groups of severely obese or nonobese Caucasian adolescents.

Greater loss in muscle mass and function but smaller metabolic alterations in older compared with younger men following 2 wk of bed rest and recovery.

This investigation aimed to compare the response of young and older adult men to bed rest (BR) and subsequent rehabilitation (R). Sixteen older (OM, age 55-65 yr) and seven young (YM, age 18-30 yr) men were exposed to a 14-day period of BR followed by 14 days of R. Quadriceps muscle volume (QVOL), force (QF), and explosive power (QP) of leg extensors; single-fiber isometric force (Fo); peak aerobic power (V̇o2peak); gait stride length; and three metabolic parameters, Matsuda index of insulin sensitivity, postprandial lipid curve, and homocysteine plasma level, were measured before and after BR and after R. Following BR, QVOL was smaller in OM (-8.3%) than in YM (-5.7%,P= 0.031); QF (-13.2%,P= 0.001), QP (-12.3%,P= 0.001), and gait stride length (-9.9%,P= 0.002) were smaller only in OM. Fo was significantly smaller in both YM (-32.0%) and OM (-16.4%) without significant differences between groups. V̇o2peakdecreased more in OM (-15.3%) than in YM (-7.6%,P< 0.001). Instead, the Matsuda index fell to a greater extent in YM than in OM (-46.0% vs. -19.8%, respectively,P= 0.003), whereas increases in postprandial lipid curve (+47.2%,P= 0.013) and homocysteine concentration (+26.3%,P= 0.027) were observed only in YM. Importantly, after R, the recovery of several parameters, among them QVOL, QP, and V̇o2peak, was not complete in OM, whereas Fo did not recover in either age group. The results show that the effect of inactivity on muscle mass and function is greater in OM, whereas metabolic alterations are greater in YM. Furthermore, these findings show that the recovery of preinactivity conditions is slower in OM.

Prediction of resting energy expenditure in severely obese Italian women

The aims of the present study were to develop and cross-validate new equations for predicting resting energy expenditure (PREE) in severely obese Italian women, and to compare their accuracy with those of the Harris-Benedict, Bernstein, WHO/FAO/UNU, Owen, Mifflin, Nelson, Siervo, Huang and Livingston equations to predict REE, using the Bland-Altman method. One hundred and eighty two women [mean body mass index (BMI) 45.6 kg/m2; 56.7% fat mass (FM)], aged 19 to 60 yr participated in this study. REE was measured by indirect calorimetry and body composition by bioelectrical analysis. Equations were derived by stepwise multiple regression analysis, using a calibration group and tested against the validation group. Two new specific equations based on anthropometric REE=Weigh tx0.042+Heightx3.619-2.678 (R2=0.66, SE=0.56 MJ) or body composition parameters REE=FF Mx0.067+FMx0.046+1.568 (R2=0.63, SE=0.58 MJ) were generated. Mean PREE were no different from the mean measured resting energy expenditure (MREE) (<1%, p>0.800) and REE was predicted accurately (95–105% of MREE) in 60% of subjects. The WHO/FAO/UNU, Harris-Benedict and Siervo equations showed mean differences <2% and PREE was accurate in <44% of subjects. The Huang, Mifflin and Livingston equations showed a mean PREE underestimation (>5.0%, p<0.001) and PREE was accurate in <38% of subjects. The Owen, Bernstein and Nelson equations showed a greater PREE underestimation (>14%, p<0.001 ) in >90% of subjects. The new prediction equations allow an accurate estimation of REE in groups of severely obese women and result in lower mean differences and lower limits of agreement between PREE and MREE than commonly used equations.

Skeletal muscle oxidative function in vivo and ex vivo in athletes with marked hypertrophy from resistance training

Oxidative function during exercise was evaluated in 11 young athletes with marked skeletal muscle hypertrophy induced by long-term resistance training (RTA; body mass 102.6 ± 7.3 kg, mean ± SD) and 11 controls (CTRL; body mass 77.8 ± 6.0 kg). Pulmonary O2 uptake (Vo2) and vastus lateralis muscle fractional O2 extraction (by near-infrared spectroscopy) were determined during an incremental cycle ergometer (CE) and one-leg knee-extension (KE) exercise. Mitochondrial respiration was evaluated ex vivo by high-resolution respirometry in permeabilized vastus lateralis fibers obtained by biopsy. Quadriceps femoris muscle cross-sectional area, volume (determined by magnetic resonance imaging), and strength were greater in RTA vs. CTRL (by ∼40%, ∼33%, and ∼20%, respectively). Vo2peak during CE was higher in RTA vs. CTRL (4.05 ± 0.64 vs. 3.56 ± 0.30 l/min); no difference between groups was observed during KE. The O2 cost of CE exercise was not different between groups. When divided per muscle mass (for CE) or quadriceps muscle mass (for KE), Vo2 peak was lower (by 15-20%) in RTA vs. CTRL. Vastus lateralis fractional O2 extraction was lower in RTA vs. CTRL at all work rates, during both CE and KE. RTA had higher ADP-stimulated mitochondrial respiration (56.7 ± 23.7 pmol O2·s(-1)·mg(-1) ww) vs. CTRL (35.7 ± 10.2 pmol O2·s(-1)·mg(-1) ww) and a tighter coupling of oxidative phosphorylation. In RTA, the greater muscle mass and maximal force and the enhanced mitochondrial respiration seem to compensate for the hypertrophy-induced impaired peripheral O2 diffusion. The net results are an enhanced whole body oxidative function at peak exercise and unchanged efficiency and O2 cost at submaximal exercise, despite a much greater body mass.

Development and cross-validation of prediction equations for estimating resting energy expenditure in severely obese Caucasian children and adolescents

The objectives of the present study were to develop and cross-validate new equations for predicting resting energy expenditure (REE) in severely obese children and adolescents, and to determine the accuracy of new equations using the Bland-Altman method. The subjects of the study were 574 obese Caucasian children and adolescents (mean BMI z-score 3.3). REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis. Equations were derived by stepwise multiple regression analysis using a calibration cohort of 287 subjects and the equations were cross-validated in the remaining 287 subjects. Two new specific equations based on anthropometric parameters were generated as follows: (1) REE=(Sex x 892.68)-(Age x 115.93)+(Weight x 54.96)+(Stature x 1816.23)+1484.50 (R(2) 0.66; se 1028.97 kJ); (2) REE=(Sex x 909.12)-(Age x 107.48)+(fat-free mass x 68.39)+(fat mass x 55.19)+3631.23 (R(2) 0.66; se 1034.28 kJ). In the cross-validation group, mean predicted REE values were not significantly different from the mean measured REE for all children and adolescents, as well as for boys and for girls (difference <2 %) and the limits of agreement (+/-2 sd) were +2.06 and -1.77 MJ/d (NS). The new prediction equations allow an accurate estimation of REE in groups of severely obese children and adolescents. These equations might be useful for health care professionals and researchers when estimating REE in severely obese children and adolescents.

Effects of low- and high-intensity exercise training on body composition and substrate metabolism in obese adolescents

The objective was to investigate the effects of a 3-week weight-management program including moderate energy restriction and exercise training at 2 intensities [low intensity (LI): 40% and high intensity (HI): 70% maximal oxygen uptake (V’O2max)] on body composition, energy expenditure, and fat oxidation rate in severely obese adolescents. Twenty obese adolescents, aged 15–17 yr (body mass index: 37.5 kg/m2; 38.2% fat mass) participated in this study. Before starting (week 0, W0) and at the end of the weight-management period (week 3, W3), body composition was assessed by a multifrequency tetrapolar impedancemeter; basal metabolic rate (BMR), energy expenditure, and substrate oxidation rate during exercise and post-exercise recovery by indirect calorimetry. At W3, body mass and fat mass decreased significantly (p<0.005) in all groups, and the decreases were significantly greater in the LI than in the HI group (−8.1 ±1.6 vs∼-5.9±1.6 kg and−4.2±1.9 vs∼-2.3±1.7 kg, p<0.05, respectively). Predicted V’O2max, expressed in relative values, changed significantly only in the HI group by +0.010±0.006 l/(kg fat-free mass × min) (p=0.010). By contrast, no significant changes were observed at W3 in BMR, energy expenditure, and substrate oxidation rate during exercise and post-exercise recovery. In conclusion, LI (40% of V’O2max) physical activity favors fat oxidation and it seems advisable to encourage obese adolescents to perform LI physical activity which is more feasible and acceptable than intense exercise.