Exercise as it relates to Disease/Resistance training and the effects it has on preventing metabolic syndrome in morbid obesity

This Wikibook contains a critical appraisal on the research article Preventing metabolic syndrome in morbid obesity with resistance training: Reporting interindividual variability. Nutrition, Metabolism and Cardiovascular Diseases by Delgado-Floody P, Álvarez C, Lusa Cadore E, Flores-Opazo M, Caamaño-Navarrete F, Izquierdo M.

What is the background to this research?
The background of the research revolves around the affect resistance training has on preventing metabolic syndrome in morbid obesity through resistance training. it has been shown that resistance training improves health markers in obesity, but there is no current research it has on morbid obesity The aim was to determine the effects of a resistance training program in the preventing the metabolic syndrome in patients with morbid obesity. A second aim of this research was to report the variability in terms of improvements in MetS markers and any other related co-variables .As stated earlier their are no current research on resistance training and morbid obesity, this will help further research when assessing resistance training and the relationship it has with morbid obesity. This is important as it will help further research and perhaps lead to improvement in obesity rates through resistance training.

Obesity can be defined by body weight, body mass index (BMI) (calculated as weight (kg) divided by height (m) squared) and body fat percentage, although there is no generally accepted classification. The reasons are multifactorial, with genetic, environmental, socio-economic and behavioural or psychological influences.The health conditions caused or exacerbated from obesity include hypertension, diabetes mellitus (DM), sleep apnea and the hypoventilation of obesity, back and articulation problems, cardiovascular disease, pseudotumora Cerebri, thromboembolic disease.

Where is the research from?
The research was conducted at Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Chile. The research was completed by a number of researchers in all departments at the Universidad de La Frontera, chile

One such researcher Pedro Delgado-Floody examines the response to various lifestyle interventions in schoolchildren, examining physical, cognitive, and academic aspects (association and response to PA). He also examines the response to various PA, nutritional education, and psychological support interventions, determining the impact of sociodemographic factors (i.e., socioeconomic, family members, marital status, etc, among others).

The study was funded by the University de La Frontera,Chile Project DI18-0043. Mikel Izquierdo is funded in part by a grant from the Ministerio de Economía, Industriay Competitividad (project number PI17/01814) Spain.

What kind of research was this?
The paper was a experimental clinical trial, patients were selected based on obese and morbid obese conditions and who were also candidates for bariatric surgery. The intervention was a lifestyle study comprising over 20 weeks while involving resistance training.

What did the research involve?
The inclusion criteria were as follows: i)>18 and 60 years of age, participation in daily activities including walking,physical autonomy, ii) medical authorisation by a physician, and iii) BMI35 kg/m2, according to the following classification: class II obesity BMI, class III morbid obesity BMI40 kg/m2

MetS indicators (waist circumference, systolic and diastolic blood pressure [BP], fasting glucose, high-density lipoproteins, and triglycerides) and other co-variables were measured in the participants (total cholesterol, low-density lipoprotein, one-maximum repetition of biceps curl, and handgrip strength, 6 min walking test)

The 20-week RT programme consisted of three 1-hour weekly sessions. To avoid injuries, each session began with a 10-minute warm-up that included continuous walking and joint mobility and flexibility exercises, followed by a 5-minute cool-down and stretching time. 4 to 8 RT exercises targeting the following muscle areas were incorporated in each session: 1. forearm, 2. knee flexors and 3. extensors, 4. trunk, 5. chest, 6. shoulder elevators, 7. horizontal shoulder flexors and 8. extensors, and 9. plantar flexors .Each muscle group's workouts were performed in three sets of as many repetitions (continuous concentric/eccentric voluntary contraction) as feasible in one minute, followed by a two-minute rest period.

Prior to starting the RT programme, each participant was assessed using a subjective modified Borg scale (1e10 points) to determine muscle exertion (i.e., the load [kg]) in 1 minute of exercise. The recovery time decreased from 2 minutes (week 1e4) to 1.5 minutes (week 5e10) and remained stable until week 20 of RT. Every two weeks, the percentage one repetition maximum (1RM) of intensity created by each exercise was gradually increased from 40 to 55 percent, based on the individuals' physiological adaptations. As a result, participants always did one minute of exercise, three times (i.e., three times) per exercise, with rest periods in between. The session lasted one hour, including the warm-up, the eight exercises, and the cool-down. Dumbbells, free weights, and metal bars were used in the exercises, which were adjusted each week in terms of individual load or participation by exercise. In a dumbbell test, the 1RM strength test intensity ranged between 20 and 40% of 1RM.

What were the basic results?
The main results of the study are that determinants of MetS including waist circumference, SBP, DBP, fasting glucose, and triglycerides, are all significantly reduced following a 20-week RT program in both subjects with obesity or morbid obesity. Also, there was no overall difference in the prevalence of non-responders in terms of improvements in MetS outcomes (in exception of body mass which is not considered a MetS criteria) after the 20 week intervention.

What conclusions can we take from this research?
The methodology of this intervention that was selected is relatively not expensive, it was also a reliable method of measuring and assessing the participants involved.

Overall, resistance training is shown to improve certain determinants of metS including waist circumference, systolic blood pressure, diastolic blood pressure, fasting glucose, and triglycerides following the resistance training intervention of 20 weeks, this was shown in the people who were morbidly obese and obese Many other studies have shown similar results, Because RT has a clinically and statistically significant influence on metabolic syndrome risk variables such obesity, HbA1c levels, and systolic blood pressure, it should be used to treat type 2 diabetes and metabolic diseases.

Although there is some studies that go against this conclusion, where they list resistance training does not have a big impact on, one research article states that, RT has been demonstrated to increase glucose tolerance, glycosylated haemoglobin, strength, and lean body mass in previous studies The impact of RT on other metabolic variables, on the other hand, is less obvious. The control of weight gain, the extent of weight loss, and changes in body composition generated by exercise training are of great interest to both the general public and the scientific community

Practical advice
The following guidelines should be followed in relation to daily exercise and sedentary time:

At least 1 hour of moderate to vigorous activity involving mainly aerobic activities per day.Vigorous activities should be incorporated at least 3 days per week.Several hours of light activities per day.

Sedentary time- Minimise and break up long periods of sitting.

Aerobic training and RT therapies improve metabolic and cardiovascular health, as well as fitness. Because RT does not necessitate a high level of cardiorespiratory fitness to begin, it is a natural place to start in a weight-loss programme, especially since muscular strength and endurance are essential in all activities of daily living

Further information/resources
Below are more resources about metabolic syndrome and morbid obesity and the symptoms that may occur. please seek guidance if you are concerned about your health.

https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians

https://www.betterhealth.vic.gov.au/health/healthyliving/resistance-training-health-benefits

https://www.heartfoundation.org.au/bmi-calculator