Objective The purpose of this study was to investigate the relationship between body mass index (BMI) class and physical activity and sedentary behavior in patients with acute coronary syndrome (ACS) during cardiac rehabilitation (CR). Methods This study was a secondary analysis of the OPTICARE trial. Physical activity and sedentary behavior were measured in participants with ACS (n = 359) using actigraphy at baseline, directly after completion of a multidisciplinary 12-week exercise-based CR program and 9 months thereafter. Outcome measures were step count and duration of time (percentage of wear time) spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior. Participants were classified as normal weight (BMI = 18.5–24.99 kg/m2; n = 82), overweight (BMI = 25.0–29.99 kg/m2; n = 182), or obese (BMI ≥ 30.0 kg/m2; n = 95). Linear mixed-effects models were applied to study the relationship between BMI class and physical activity and sedentary behavior. Results At the start of CR, compared with participants with normal weight, participants with obesity made on average 1.11 steps fewer per minute (952 steps/d), spent 2.9% (25 min/d) less time in light physical activity, and spent 3.31% (28 min/d) more time in sedentary behavior. Participants of all BMI classes improved their physical activity and sedentary behavior levels similarly during CR, and these improvements were maintained after completion of CR. Conclusion Participants with ACS who had obesity started CR with a less favorable physical activity and sedentary behavior profile than that of participants with normal weight. Because all BMI classes showed similar improvement during CR, this deficit was preserved. Impact This study indicates that reconsideration of the CR program in the Netherlands for patients with ACS and obesity is warranted, and development of more inclusive interventions for specific populations is needed. A new program for people with obesity should include added counseling on increasing physical activity and preventing sedentary behavior to facilitate weight loss and reduce mortality risk. Lay Summary People with ACS who have obesity are less active and sit more than individuals with normal weight, both during and after CR. This study suggests that CR needs to be changed to help individuals increase their physical activity to help them lose weight and reduce their risk of death.
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Rationale: Sarcopenia and obesity are prevalent conditions and are both associated with negative health outcomes. ESPEN and EASO reached consensus on the definition and diagnostic criteria for sarcopenic obesity (SO) encompassing indicators fat mass, muscle mass, and muscle function. However, few studies report on the effect of lifestyle interventions on these SO indicators. This study aimed to evaluate the effect of combined lifestyle interventions on SO indicators and on a composite SO index.Methods: Analyses were performed on two pooled RCT’s (MPS, PROBE) in older adults with obesity participating in a 13-wk program targeting weight loss while preserving muscle mass, providing a combination of caloric restriction, higher protein intake and resistance exercise training. SO indicators measured at baseline and post-intervention included 5x chair stand test (CST) in seconds for muscle function, fat mass percentage (FM%) and appendicular lean mass divided by body weight (ALM/W) using DXA. The SO index was calculated using sex-specific z-scores: -CST(s) + ALM/W – FM%; higher scores indicating better muscle function and body composition. Mixed model analyses were performed to assess the changes from baseline to post-intervention, adjusted for sex and age.Results: A total of 154 participants (age 65±6y; 59% male, BMI 33.1±4.3kg/m2) were included. After the 13-wk lifestyle interventions, weight (-2.87kg 95%CI -4.16;-1.64) and FM% (-1.81% 95%CI -2.42;-1.21) decreased significantly, CST improved significantly (-1.51s 95%CI -2.02;-1.00) from baseline and ALM/W was maintained (0kg/kg 95%CI 0.01;0.01). The SO index improved (+1.16 z-score 95%CI 0.86;1.44).Conclusion: Lifestyle interventions combining nutrition & exercise improved individual SO indicators and the SO index in older adults with obesity. The SO index could be a useful and sensitive criterion in the prevention and management of sarcopenic obesity.
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Rationale: Patients with cancer of the upper gastrointestinal tract or lung are more likely to present with malnutrition at diagnosis than, for instance, patients with melanoma. Low muscle mass is an indicator of malnutrition and can be determined by computed tomography (CT) analysis of the skeletal muscle index (SMI) at the 3rd lumbar vertebra (L3) level. However, CT images at L3 are not always available. At each vertebra level, we determined if type of cancer, i.e., head and neck cancer (HNC), oesophageal cancer (OC) or lung cancer (LC) vs. melanoma (ME) was associated with lower SMI. Methods: CT images from adult patients with HNC, OC, LC or ME were included and analyzed. Scans were performed in the patient’s initial staging after diagnosis. MIM software version 7.0.1 was used to contour the muscle areas for all vertebra levels. Skeletal muscle area was corrected for stature to calculate SMI (cm2/m2). We tested for the association of HNC, OC, or LC diagnosis vs ME with SMI by univariate and multivariate linear regression analyses. In the multivariate analyses, age (years), sex, and body mass index (BMI; kg/m2) were included. Betas (B;95%CI) were calculated and statistical significance was set at p
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Aanleiding De somatische zorg voor patiënten met een ernstige psychische aandoening (EPA) schiet in de Nederlandse gezondheidszorg op een aantal punten ernstig tekort. Dit leidt ertoe dat deze patiënten eerder ziek worden en een beduidend kortere levensverwachting hebben dan gemiddeld. In navolging van de groeiende aandacht binnen de gezondheidszorg voor dit thema, zijn er landelijk twee multidisciplinaire richtlijnen ontwikkeld. De eerste richtlijn is voor somatische screening bij patiënten met EPA en de tweede voor de toepassing van leefstijlinterventies ter bevordering van de gezondheid van deze patiënten. De interventies vinden o.a. plaats op voeding, bewegen, roken, alcoholgebruik, middelenmisbruik, slaap en seksueel risicovol gedrag. In dit RAAK-project worden de twee richtlijnen aan de praktijk getoetst. Doelstelling Het RAAK-project beoogt implementatie en evaluatie van de reeds ontwikkelde richtlijnen in twee GGZ-instellingen bij een groep van 750 patiënten. De (post-)hbo-opgeleide verpleegkundig specialisten vervullen een spilfunctie bij de uitvoering van de screening en de leefstijlinterventies en hebben een coördinerende functie naar andere betrokken disciplines (arts, psychiater, diëtist, fysiotherapeut, etc.). Bij gebleken gezondheidsproblemen wordt effectieve behandeling ingezet, gemonitord en geëvalueerd. Ter ondersteuning van de verpleegkundigen zijn de belangrijkste aanbevelingen uit de richtlijnen vertaald in twee methodieken: de Verpleegkundige Monitoring bij Somatiek en Leefstijl (VMSL-GGZ) en Leefstijl in Beeld. Hierbij horen e-healthtools en een e-learningmodule. Een uitgebreide evaluatie zal uitwijzen of de richtlijnen rond somatiek en leefstijl effectief geïmplementeerd kunnen worden in de GGZ-beroepspraktijk. Boogde resultaten Het project brengt tot op het niveau van de patiënt de resultaten in beeld van het werken met richtlijnen en methodieken bij: 1) screening van patiënten met een ernstige psychische aandoening op dreigende gezondheidsproblemen; 2) toepassing van interventies als de gezondheid in gevaar is. De bij de methodieken horende e-healthtools en e-learningmodule zijn doorontwikkeld en breed inzetbaar. Verspreiding van kennis en ervaring die is opgedaan in het project vindt plaats via de netwerken van het consortium. Borging van de inzichten in het onderwijs is eveneens een primaire doelstelling.
