Wendy Hens

The Effect of Exercise on Visceral Adipose Tissue in Overweight Adults: A Systematic Review and Meta-Analysis

Excessive visceral adipose tissue appears to trigger a cascade of metabolic disturbances that seem to coexist with ectopic fat storage in muscle, liver, heart and the ß-cell. Therefore, the reduction of visceral adipose tissue potentially plays a pivotal role in the treatment of the metabolic syndrome. The purpose of this systematic review and meta-analysis is to describe the overall effect of exercise on visceral adipose tissue and to provide an overview of the effect of different exercise regimes, without caloric restriction, on visceral adipose tissue in obese persons. A systematic literature search was performed according to the PRISMA statement for reporting systematic reviews and meta-analyses. The initial search resulted in 87 articles after removing duplicates. After screening on title, abstract and full-text 15 articles (totalling 852 subjects) fulfilled the a priori inclusion criteria. The quality of each eligible study was assessed in duplicate with “The Critical Review Form for Quantitative Studies”. Using random-effects weights, the standardized mean difference (Hedges g) of the change in visceral adipose tissue was −0.497 with a 95% confidence interval of −0.655 to −0.340. The Z-value was −6.183 and the p-value (two tailed) was <0.001. A subgroup analysis was performed based on gender, type of training and intensity. Aerobic training of moderate or high intensity has the highest potential to reduce visceral adipose tissue in overweight males and females. These results suggest that an aerobic exercise program, without hypocaloric diet, can show beneficial effects to reduce visceral adipose tissue with more than 30 cm2 (on CT analysis) in women and more than 40 cm2 in men, even after 12 weeks.

Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation — A systematic review and descriptive meta-analysis

The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science) assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at p≤0.05. Overall, the presentation of EOV significantly indicated aggravated prognostic markers. Subgroup analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. In general, these findings suggest that the presence of EOV in patients with HF is associated with a deterioration of the prognostic CPET parameters. Furthermore, EOV can occur in HF patients with reduced as well as preserved ejection fraction. Further research on defining and assessing EOV in a more accurate and reproducible way is required.

Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association)

Worldwide, an obesity epidemic among children and adolescents is apparent. In the care of obesity in children and adolescents, exercise therapy is considered a cornerstone. Official position statements describe and endorse the need and effect of exercise therapy and increased physical activity in children and adolescents with obesity. Physical therapists working in private and home care settings (first-line treatment) can play a key role in maximizing participation rates in exercise and physical activity programs, thereby increasing the community-scale clinical benefits of increased physical activity. However, it remains unclear how such guidelines can be efficiently applied in private practice and home care physical therapy settings given the limited equipment, infrastructure and time. In this clinical recommendation, a systematic, effective, and feasible approach for pre-participation screening and implementation of exercise interventions or increased physical activity programs in children and adolescents with obesity is provided for first-line physical therapists. This clinical recommendation aims to provide a guideline for physical therapists in private practice and home care settings to prescribe clinically effective and medically safe exercise interventions for children and adolescents with obesity, thereby contributing to better care and treatment of obesity in these children and adolescents.

The effect of diet or exercise on ectopic adiposity in children and adolescents with obesity: a systematic review and meta‐analysis

Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta‐analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population.

Response to letter to the editor: "Exercise oscillatory ventilation — Perfusion abnormality in heart failure"☆

a University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium b Bern University of Applied Sciences (Health), Murtenstrasse 10, CH-3008 Bern, Switzerland c Vrije Universiteit Brussel (Faculty of Physical Education and Physical Therapy), Pleinlaan2, B-1050 Elsene, Belgium d Antwerp University Hospital (Department of Cardiology), Wilrijkstraat 10, B-2650 Edegem, Belgium e University of Antwerp (Faculty of Medicine and Health Sciences), Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium