Search

This chapter firstly describes target behaviours for chronic diseases, chosen based on their prevalence and potential for self-management: type 2 diabetes, chronic obstructive pulmonary disease, hypertension, heart failure, obesity, asthma and ischaemic heart disease. High-level target behaviours (e.g. diet, physical activity, medication adherence, smoking cessation, symptom monitoring and management) are presented for each of these diseases when applicable, accompanied by low-level target behaviours. Next, we address ways of assessing these target behaviours – diet, physical activity, medication adherence and smoking cessation – a necessary first step for understanding these behaviours and identifying needs.

The final chapter presents open-access educational products that supplement this book: case studies and a web application to simulate behaviour change support in persons with chronic disease. The former is of particular interest for academic educators, while the latter may interest students independently pursuing training outside the classroom. These products can also be useful for professionals aiming to enhance behaviour change competencies in practice.First, we address key aspects of product development , including hallmarks such as the incorporation of behaviour change science and transnational co-production with users. Then, the main features of case studies and the web application with 2D virtual humans are described.

Rationale Cancer is associated with muscle wasting. However, optimal protein intake has not been determined, limiting the efficacy of nutritional interventions. This systematic review aims to assess the effect of protein intake on muscle mass of patients with cancer types with high prevalence of sarcopenia during treatment, in longitudinal studies. Methods MEDLINE, CINAHL, and Scopus databases were searched following PRISMA guidelines. Longitudinal studies written in English, including adults with high sarcopenia prevalence cancer diagnosis, submitted to (chemo)radiotherapy, with assessment of protein intake and muscle changes during treatment, published until 4 October 2020 were included. Studies including supplementation with substances, such as n-3 fatty acids, specific amino acids, or proteins, were excluded. Study appraisal was independently conducted by two reviewers, and a qualitative research synthesis was performed. Results Overall, 575 records were identified, of which, eight studies were included (one randomized clinical trial and seven uncontrolled before and after studies). Patients with head and neck (n = 5), lung (n = 2), and esophageal cancer (n = 1) were included, comprising a total of 554 participants. The studies presented heterogeneous methodologies, objectives, and methods to assess body composition. Overall, participant groups with a mean protein intake below 1.2 g/kg presented muscle wasting, with one exception, while those reporting a mean intake above 1.4 g/kg, maintained muscle during treatment. Conclusions Our findings show that protein intakes below 1.2 g/kg, even when within the recommendations, have been associated with muscle wasting during treatment. Only intakes above 1.4 g/kg have been associated with muscle maintenance. High-quality research is needed to establish an optimal dose response.

Background: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. Methods: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. Results: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. Conclusion: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. Methods: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. Results: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. Conclusions: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population.

Introduction Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITIONː This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials. Evidence synthesis We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA. Conclusions There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.

Aim To develop and validate a physical exercise programme aimed at delaying the functional decline in frail older adults. Design The revised guideline of Criteria for Reporting the Development and Evaluation of Complex Interventions in health care was followed. Methods The physical exercise programme was designed and validated by exercise specialists to be implemented by healthcare professionals. The physical exercise programme underwent three stages of development, piloting and evaluation. It includes a portfolio of exercises in different support materials (posters, e‐book and website). A testing intervention was delivered to the target population. Results The Criteria for Reporting the Development and Evaluation of Complex Interventions in health care process has the potential to help practitioners in developing and planning complex interventions, such as an exercise programme. Its components can be adjusted to the context and to the characteristics of the target population. A study protocol and a pilot study will be developed to test the effectiveness of the physical exercise programme on delaying the functional decline of frail older adults.

Background: Breast cancer is the most common malignancy among women worldwide. The treatments may also cause neuromuscular and skeletal disorders; therefore, the aim of this study was to verify the existence of a relationship between heart rate variability and different functional fitness parameters in women survivors of breast cancer. Methods: This cross-sectional study included 25 women survivors of breast cancer, with a mean ± SD age, height, and body mass of 50.8 ± 8.8 years, 1.6 ± 0.7 m, and 67.1 ± 12.3 kg, respectively. Patients underwent measurements of heart rate variability with time and frequency domain analyses, as well as a “30 s chair-stand test”, “6 min walking test”, “timed up and go test”, and “ball throwing test”. Results: A multiple linear regression analysis showed that from the heart rate variability frequency domain, high frequency explained 21% (R2 = 0.21) of the “30 s chair-stand test” performance. Conclusion: The findings of this study highlight high frequency as a predictor of “30 s chair-stand test” performance, regardless of age and time after diagnosis, suggesting its usefulness as a clinical indicator of functionality in breast cancer survivors. This study presents a straightforward and non-invasive methodology predicting functional fitness in women breast cancer survivors potentially applicable to clinical practice.

Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers’ physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.

Dissertação de mestrado em Engenharia Industrial (área de especialização em Gestão Industrial), O presente projeto foi desenvolvido na Bosch Car Multimedia Portugal, em Braga, no âmbito da dissertação de Mestrado em Engenharia Industrial, na Universidade do Minho. No âmbito do projeto “Go for Profit”, desenvolvido a nível mundial pela Bosch, cujo objetivo principal passa pela redução dos desperdícios nas áreas produtivas, a Bosch Car Multimedia Portugal decidiu instalar uma nova linha de produção para reutilização de componentes. Neste contexto, o projeto desenvolvido, no âmbito desta dissertação de mestrado, teve como objetivo criar uma linha de produção económica, ajustada às necessidades e eficaz no seu objetivo. Com recurso às ferramentas Lean, das quais se destaca o P-FMEA, foi possível definir as melhores soluções técnicas e passos a executar na linha de reutilização de componentes. Como complemento à componente técnica, e através da criação de mapas financeiros, realizou-se a análise ao investimento efetuado. Por outro lado, através da criação de cenários, foi possível simular diferentes condições a que a linha de reutilização de componentes pode estar sujeita. A análise de resultados mostra que, não sendo possível eliminar na totalidade a rejeição existente da linha de produção do produto alvo deste projeto, a implementação da linha de reutilização de componentes provou-se eficaz e necessária para que a Bosch possa reduzir o prejuízo previsto de sete milhões para um milhão de euros, por ano, no futuro próximo. Com efeito, mesmo nas piores condições simuladas, a linha de reutilização de componentes mostrou-se viável desde o primeiro ano da sua implementação demonstrado pelo valor da Taxa Interna de Rentabilidade de 78%. De realçar ainda que sendo a linha de reutilização de componentes um novo tipo de processo existente na empresa, e apesar do sucesso da sua instalação, o arranque das atividades de melhoria contínua e consequente atualização do P-FMEA, possibilitarão a sua otimização e aumento da capacidade produtiva., The present dissertation was developed on Bosch Car Multimedia Portugal, in Braga, within the scope of the Master Degree dissertation, at Universidade do Minho. In the scope of the project “Go for Profit”, applied worldwide by the Bosch Group, which aims to reduce the waste, mainly, on the productive areas, Bosch Car Multimedia Portugal decided to implement a new production line to reuse componentes. In this context, the developed project on the scope of this Master Degree dissertation, aims to create an economic, adjusted to his needs and effective production line. Using Lean tools, highlighting the P-FMEA, it was possible to define the suitable technical solutions for each steps that must be executed on the reusing components production line. As a complement to the technical component and through the creation of financial statements, an analysis was made to the investment made. On the other hand, by creating scenarios, was possible to simulate different conditions that the reusing components production line may be subjected to. The result analysis shows that, since is not possible to eliminate completely the rejection on the production line of the target product of this project, the implementation of the reusing components production line proved viable and needed to support Bosch decreasing the predicted loss from seven millions euros to one million euros, per year, on the near future. In fact, even in the worst simulated conditions, the reusing components production line proved viable since the first year after its implementation, demonstrated by the Internal Rate Return of 78%. It should also be noted that, being the reusing components production line a new type of process in the company and, besides the success of his implementation, initiate the continuous improvement tasks and consequently update the P-FMEA, will enable its optimization and increased productive capacity.

espanolObjetivo: Estimar el gasto total de energia y la intensidad de una rutina de BodyattackTM de bajo impacto. Metodos: Los participantes fueron 10 adultos de peso normal (33 ± 3 anos). La potencia maxima de oxigeno y la frecuencia cardiaca (FC) se determinaron por el rendimiento en una prueba de ejercicio maxima utilizando el metodo calorimetrico indirecto. Los valores de la frecuencia cardiaca y del gasto total de energia se monitorearon durante una rutina utilizando un sensor combinado de frecuencia cardiaca y movimiento. Resultados: Una clase de BodyattackTM de bajo impacto de 60 minutos exige un gasto total de energia de 469.4 ± 170.8 kcal a una intensidad promedio del 64% de la frecuencia cardiaca maxima, de los cuales 27.2 minutos se gastan en actividad fisica de intensidad moderada a vigorosa. En comparacion con una clase de alto impacto, el gasto total de energia fue menor en la opcion de bajo impacto (-194.8 Kcal, p=0.006), pero no se encontraron diferencias en la intensidad promedio (-9.4%, p=0.707). Conclusion: Las clases de Bodyattack™ de bajo impacto pueden cumplir con las recomendaciones minimas para desarrollar y mantener la aptitud cardiorrespiratoria, si se practican mas de tres dias por semana. Sin embargo, los requisitos de energia de Bodyattack ™ de bajo impacto pueden no provocar una perdida de peso efectiva. EnglishObjective: To estimate total energy expenditure and intensity of a low impact BodyattackTM session using combined heart rate and movement sensing technology. Method: Participants were 10 (8 males) normal-weight adults (33 ± 3 years-old). Maximal oxygen capacity and heart rate were determined by the performance on a treadmill maximal exercise test using indirect calorimetric method. Heart rate and energy expenditure values were monitored during a Bodyattack™ routine using a combined heart rate and movement sensor. The manufacturer's combined activity and heart rate algorithm was used to estimate Total and Physical activity energy expenditure. Results: A 60 min low impact BodyattackTM session demands a Total energy expenditure of 469.4 ± 170.8 kcal at an average intensity of 64% of maximal heart rate, from which approximately 27.2 min are spent at moderate to vigorous physical activity intensities. Compared to a high impact BodyattackTM session as reported by the trademark company, Total energy expenditure was lower in the low impact option (-194.8 Kcal, p=0.006), but no significant differences were found in average intensity (-9.4%, p=0.707). Conclusion: Bodyattack™ routines performed at a low impact option may be sufficient to meet minimal recommendations for developing and maintaining cardiorespiratory fitness, if practiced beyond three days.week-1. Although appropriate for untrained individuals and those with orthopedic limitations, energy requirements of low impact Bodyattack™ may not be enough to elicit an effective weight loss. portuguesObjetivo: Estimar o dispendio energetico total (DE) e a intensidade de uma aula de BodyattackTM de baixo impacto. Metodo: Dez adultos com peso normal (33 ± 3 anos) participaram neste estudo. O consumo maximo de oxigenio e a frequencia cardiaca (FC) foram determinadas por calorimetria indireta em resposta a um teste de esforco maximo. A FC e o dispendio energetico total foram monitorizados continuadamente durante a aula usando um sensor combinado de FC e movimento. Resultados: Uma aula de 60 minutos de BodyattackTM de baixo impacto solicita um dispendio energetico total de 469.4 ± 170.8 kcal a uma intensidade media de 64% da FC maxima, dos quais 27.2 minutos sao gastos em atividades fisicas de intensidade moderada a vigorosa. Em comparacao com uma rotina de alto impacto, o dispendio energetico total foi menor na opcao de baixo impacto (194.8 Kcal, p = 0.006), mas nao foram encontradas diferencas na intensidade media (-9.4%, p = 0.707). Conclusao: As aulas de Bodyattack™ de baixo impacto podem alcancar as recomendacoes minimas para o aumento e manutencao da aptidao aerobia, desde que praticadas tres ou mais dias por semana. No entanto, o dispendio energetico total de uma aula de Bodyattack™ de baixo impacto pode nao concorrer para uma perda de peso efetiva.

Introduction: Engaging undergraduate students in faculty-led research is documented as a mutually valuable experience [1,2]. The VASelfCare project started in January 2018 (http://vaselfcare.rd.ciencias.ulisboa.pt); it aims to develop and test a software prototype with a virtual assistant, to facilitate self-care of older people with type 2 diabetes. The project entails the involvement of undergraduate nursing students at the consortium’s lead Institution (ESEL). The purpose of this paper is to describe the strategy for students’ participation and present its first results. Materials and methods: The implementation strategy was informed by prior experience of the research team and relevant literature. A call for applications was launched within ESEL, targeting 2nd to 4th year students. The call provided information about the project, the required student profile and the selection process. In this early phase, participation consisted of expanding the literature review on features of virtual assistant softwares. After an initial meeting, each student was assigned a specific task. Students worked in pairs and presented their work in two meetings with the multidisciplinary research team, scheduled over the course of roughly two months. Students’ opinion was ascertained at the end of this phase by means of an anonymous questionnaire, comprised by four open questions and five closed questions. Results: All the 12 applications were selected. There was a predominance of 3rd year students (n = 5). Of the 11 students who completed this phase, six responded to the questionnaire and consented to the use of data in publications related to the project. Participation was described in one word using terms such as “challenging” and “interesting”. Students perceived their involvement as an opportunity to contact with research and innovation, to develop competencies and to network with students with different background. Views on less positive aspects pertained mainly to the small exposure to research. Students’ expressed willingness to be involved in more phases of the project and to be informed about its results. They unanimously agreed (6/6) that participation contributed to improving their understanding of novel situations in a different scientific area and to the development of skills in scientific literature analysis. Discussion and conclusions: Thorough recruitment, assigning specific tasks, peer support and regular meetings were an effective strategy for involving students. This is in line with previous findings [2], and may be of help to researchers in other institutions and disciplines. Overall, students’ opinion on their experience were favourable. Future perspectives include awarding course credit for students’ participation, to enable more in-depth involvement without overloading their schedule and to further stimulate their interest in research.

Accurate predictive tools are key factors for cancer care. Phase angle (PhA) has been proposed as a marker of cellular health, particularly of cell-membrane integrity. Cutoff values have been proposed, including for cancer survivors. This study aimed to assess the usefulness of the proposed PhA cutoff, as a marker of bioelectrical impedance analysis (BIA) assessed health-status, and functional capacity in breast cancer (BC) survivors. This cross-sectional study included 25 women (50.6 ± 8.6 yrs) survivors of BC, divided into two groups according to the PhA reference value of 5.6° (group 1 [G1]: PhA ≤ 5.6° [n=13]; group 2 [G2]: PhA > 5.6° [n=12]) (Gupta et al. 2008). BIA-assessed health status parameters included: extracellular water (ECW), intracellular water (ICW), total body water (TBW), PhA, body mass, fat-free mass, muscle mass, body cell mass (BCM). Four functional tests were performed: 30 s chair-stand test, timed up and go test, ball throw test and 6-minute walking test. Results showed G2 had lower ECW/ICW ratio (p=0.001; ES=1.2), ECW/BCM ratio (p=0.001; ES=3.2) and ECW/TBW ratio (p=0.001; ES=4.8). There was no difference in functional capacity between groups. The results of the present study show that patients with higher PhA values have a higher ICW values and preservation in the ECW/ICW ratio, suggesting it's a better cell membrane quality and integrity. Relation of both PhA and cell membrane integrity with functional capacity warrants further research.

The study of body composition is a fascinating branch of the biological sciences where research and clinical practice go hand in hand. A strong theoretical background is needed to support the assessment and interpretation of body composition measurements, in order to have an impact and usefulness in the clinical setting. Body composition is a key component of health-related fitness with physical, morphological, and particularly important health-related implications during pregnancy. Pregnancy poses a major challenge for the study of body composition, as several techniques and overall methods and related assumptions are often not applicable, and pregnancy therefore requires specific assessment approaches. In the present chapter, we present a look into body composition fundamentals, how body composition can be assessed during pregnancy and what adaptations should be taken into consideration in the assessment and interpretation of body composition data. In the final section of the present chapter, a focus will be put on the effect of exercise on body composition during pregnancy.

Diabetes has significant clinical, economic and humanistic implications, both at a national and global level. Type 2 diabetes (T2D) is highly prevalent in older people. This paper describes a first prototype of an application intended to facilitate self-care of older people with T2D, supplementing appointments with healthcare professionals. The application is based on a virtual assistant with an anthropomorphic representation. The virtual assistant is capable of speaking and expressing emotions through facial and body animations; it has been designed to act as a relational agent, developing long-term relationships with users. It targets adherence to medication, physical activity and diet, tailoring the intervention to users’ needs and characteristics. The Behavior Change Wheel was chosen as the theoretical approach to behaviour change and supports dialogue content. Built for Android devices, the architecture of the application first prototype includes a core component, a dialogue creator, a speech generator and a database. The first tests on the application contents and usability were conducted in a sample of ten academic nurses with expertise in primary care. Overall, these tests yielded a positive opinion, as well as suggestions for improvement. On-going work includes testing the first prototype with older people with T2D plus health professionals in primary care units of the Portuguese National Health Service, and incorporating a rule-based context-sensitive dialogue manager, which is expected to convey a more flexible dialogue flow.

The aim of this cross-sectional study was to examine the influence of muscular strength on carotid intima-media thickness (cIMT) in children, controlling for the effect of cardiorespiratory fitness (CRF) and central adiposity and to examine if differences among muscular strength tertiles translate to physiological differences. We assessed cIMT of the common carotid artery in 366 children between 11-12 years of age (191 girls). Measures included cIMT assessed with high-resolution ultrasonography, a maximal handgrip strength test, body fat mass and lean mass from DXA and CRF determined using a maximal cycle ergometer test. Association between muscular strength and cIMT adjusted for CRF and central adiposity, as measured by trunk fat, was tested with multiple linear regression analysis. Differences in risk factors among muscular strength groups were tested with ANOVA. The Muscular Strength Index (MSI) was inversely associated with cIMT independently of CRF and central adiposity (p

It is unclear if cardiorespiratory fitness (CRF) can be used as a screening tool for premature changes in carotid intima-media thickness (cIMT) in paediatric populations. The purpose of this cross-sectional study was 3-fold: (i) to determine if CRF can be used to screen increased cIMT; (ii) to determine an optimal CRF cut-off to predict increased cIMT; and (iii) to evaluate its ability to predict increased cIMT among children in comparison with existent CRF cut-offs. cIMT was assessed with high-resolution ultrasonography and CRF was determined using a maximal cycle test. Receiver operating characteristic analyses were conducted in boys (n = 211) and girls (n = 202) aged 11–12 years to define the optimal sex-specific CRF cut-off to classify increased cIMT (≥75th percentile). Logistic regression was used to examine the association between the CRF cut-offs with the risk of having an increased cIMT. The optimal CRF cut-offs to predict increased cIMT were 45.81 and 34.46 mL·kg−1·min−1 for boys and girls, respectively. The odds-ratios for having increased cIMT among children who were unfit was up to 2.8 times the odds among those who were fit (95% confidence interval: 1.40–5.53). Considering current CRF cut-offs, only those suggested by Adegboye et al. 2011. (Br. J. Sports Med. 45(9): 722–728) and Boddy et al. 2012 (PLoS One, 7(9): e45755) were significant in predicting increased cIMT. In conclusion, CRF cut-offs (boys: ≤ 45.8; girls: ≤ 34.5 mL·kg−1·min−1) are associated with thickening of the arterial wall in 11- to 12-year-old children. Low CRF is an important cardiovascular risk factor in children and our data highlight the importance of obtaining an adequate CRF.

Objective: To analyze the body fat (BF) content and distribution modifications in coronary artery disease (CAD) patients in response to a 1-year combined aerobic and resistance exercise training (CET) program. Design and Methods: We followed two groups of CAD male patients for 12 months. One group consisted of 17 subjects (57 ± 12 years) who engaged in a CET program (CET group) and the other was a age-matched control group of 10 subjects (58 ± 11 years). BF content and distribution were measured through dual energy X-ray absorptiometry (DXA) at baseline and follow-up. Results: We found no differences on body mass and BMI between baseline and end of follow-up in both groups but, in CET group, we found significant reductions in all analyzed BF depots, including total BF (21.60 ± 6.00 vs. 20.32 ± 5.89 kg, P < 0.01), % total BF (27.8 ± 5.5 vs. 26.4 ± 5.4%, P < 0.05), trunk fat (12.54 ± 3.99 vs. 11.77 ± 4.01 kg, P < 0.05), % trunk fat (31.1 ± 6.9 and 29.2 ± 7.1%, P < 0.05), appendicular fat (8.22 ± 2.08 vs. 7.72 ± 2.037 kg, P < 0.01), % appendicular fat (25.7 ± 4.9 and 24.5 ± 4.9%, P < 0.05), and abdominal fat (2.95 ± 1.06 vs. 2.75 ± 1.10 kg, P < 0.05). Control group showed significant increase in appendicular fat (7.63 ± 1.92 vs. 8.10 ± 2.12 kg, P < 0.05). Conclusions: These results confirm the positive effect of CET on body composition of CAD patients, despite no changes in body mass or BMI. In this study, we observed no alterations on BF distribution meaning similar rate of fat loss in all analyzed BF depots. These results also alert for the limitations of BMI for tracking body composition changes.

This is the peer reviewed version of the following article: Pimenta N.M., Cortez-Pinto H., Melo X., Silva-Nunes J., Sardinha L.B. & Santa-Clara H. (2017) Waist-to-height ratio is independently related to whole and central body fat, regardless of the waist circumference measurement protocol, in non-alcoholic fatty liver disease patients. J Hum Nutr Diet. 30, 185–192, which has been published in final form atdoi: 10.1111/jhn.12410. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Background: Waist-to-height ratio (WHtR) has been reported as a prefer-able risk related body fat (BF) marker, although no standardised waistcircumference measurement protocol (WCmp) has been proposed. Thepresent study aimed to investigate whether the use of a different WCmpaffects the strength of relationship between WHtR and both whole andcentral BF in non-alcoholic fatty liver disease (NAFLD) patients.Methods: BF was assessed with dual energy X-ray absorptiometry (DXA) in28 NAFLD patients [19 males, mean (SD) 51 (13) years and nine females,47 (13) years]. All subjects also underwent anthropometric evaluationincluding height and waist circumference (WC) measurement using fourdifferent WCmp (WC1, minimal waist; WC2, iliac crest; WC3, mid-distancebetween iliac crest and lowest rib; WC4, at the umbilicus) and WHtR wascalculated using each WC measurements (WHtR1, WHtR2, WHtR3 andWHtR4, respectively). Partial correlations were conducted to assess the rela-tion of WHtR and DXA assessed BF.Results: All WHtR were particularly correlated with central BF, includingabdominal BF (r = 0.80, r = 0.84, r = 0.84 and r = 0.78, respectively, forWHtR1, WHtR2, WHtR3 and WHtR4) and central abdominal BF (r = 0.72,r = 0.77, r = 0.76 and r = 0.71, respectively, for WHtR1, WHtR2, WHtR3and WHtR4), after controlling for age, sex and body mass index. There wereno differences between the correlation coefficients obtained between allstudied WHtR and each whole and central BF variable.Conclusions: Waist-to-height ratio was found a suitable BF marker in thepresent sample of NAFLD patients and the strength of the relationshipbetween WHtR and both whole and central BF was not altered by usingdifferent WCmp in the present sample of NAFLD patients. FUNDING SOURCES The first author of this paper was supported by a research grant (PhD scholarship) from the Foundation for Science and Technology (FCT), Ministry of Education and Science of Portugal (grant: SFRH/ BD/ 70515/ 2010). The present study was funded by: the Centre for the Study of Human Performance, Portuguese Foundation for Science and Technology, Lisbon, Portugal. info:eu-repo/semantics/publishedVersion

The growing competitiveness of modern sport means that children, from very early ages, are increasingly submitted to intensive training programmes. These programmes are problematic for young athletes not only because their developing bodies are particularly susceptible to different kinds of injuries, but because athletes are also particularly vulnerable to experiences of different kinds of abuses. Using data collected through semi-structured interviews this study examines the various kinds of abuse that former Portuguese female gymnasts underwent during their sporting careers. Interviewees were asked to reflect on their past experiences and discuss aspects of the gymnastics subculture. Weight control, training/competing with injuries and corporal punishment emerged as key themes. The study therefore shows that the physical and psychological abuse of young athletes occurs even beyond the confines of elite professional sport, and thus that a broader spectrum of athletes learn to consider these forms of exploitation and abuse as normal.

Xavier Melo is supported by a research grant from the Foundation for Science and Technology (FCT), Ministry of Education and Science of Portugal (grant: SFRH/ BD/ 70515/ 2010). Nuno M. Pimenta is cofinanced by national funds through the Programa Operacional do Alentejo 2007-2013 (ALENT-07-0262- FEDER-001883) This study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and β (echo-tracking), contralateral carotid blood pressure, and upper and lower limb and central/aortic PWV (applanation tonometry) were taken at rest and 10 min after a bout of maximal treadmill running in 34 children (7.38 ± 0.38 years) and 45 young adults (25.22 ± 0.91 years) having similar aerobic potential. Two-by-two repeated measures analysis of variance and analysis of covariance were used to detect differences with exercise between groups. Carotid pulse pressure (PP; η(2) = 0.394) increased more in adults after exercise (p < 0.05). Compliance (η(2) = 0.385) decreased in particular in adults and in those with high changes in distending pressure, similarly to stiffness index α and β. Carotid PWV increased more in adults and was related to local changes in PP but not mean arterial pressure (MAP). Stiffness in the lower limbs decreased (η(2) = 0.115) but apparently only in those with small MAP changes (η(2) = 0.111). No significant exercise or group interaction effects were found when variables were adjusted to height. An acute bout of maximal exercise can alter arterial stiffness and hemodynamics in the carotid artery and within the active muscle beds. Arterial stiffness and hemodynamic response to metabolic demands during exercise in children simply reflect their smaller body size and may not indicate a particular physiological difference compared with adults. info:eu-repo/semantics/publishedVersion

Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in nonalcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 years, and 9 females, 47 ± 13 years). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r = .47 for WHR1; r = .59 for WHR2 and WHR3; r = .58 for WHR4) and BF distribution (r = .45 for WHR1; r = .56 for WHR2 and WHR3; r = .51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.

Central fat accumulation is important in nonalcoholic fatty liver disease (NAFLD) etiology. It is unknown whether any commonly used waist circumference measurement protocol (WCmp), as a whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WCmp to be used in patients with NAFLD, based on 3-fold criteria.Body fat (BF) was assessed through dual-energy x-ray absorptiometry in 28 patients with NAFLD (19 men, 51 ± 13 years; 9 women, 47 ± 13 years). WC was measured with 4 types of WCmp: WC1, narrowest torso; WC2, just above iliac crest; WC3, middistance between iliac crest and last rib; WC4, at the umbilicus.All WC measurements were highly correlated with central BF depots, including trunk BF (r = 0.78, r = 0.82, r = 0.82, r = 0.84 for WC1, WC2, WC3, and WC4, respectively), abdominal BF (r = 0.78, r = 0.78, r = 0.80, r = 0.72 for WC1, WC2, WC3, and WC4, respectively), and central abdominal BF (r = 0.76, r = 0.77, r = 0.78, r = 0.68 for WC1, WC2, WC3, and WC4, respectively), controlling for age, sex, and body mass index. There were no differences between the correlation coefficients obtained between all studied waist circumference measurements and each whole and central analyzed BF variable.All studied WCmps seem suitable for use in patients with NAFLD, particularly as a central BF clinical assessment tool, though not interchangeably. Hence, biological and precision criteria alone did not sanction the superiority of any WCmp. Practical criteria may endorse WC measured at the iliac crest.

Summary Background Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima-media-thickness (cIMT) better than either measure alone. Objective The objective of the study is to identify the ability of a combination of simple anthropometric screening tools or a combination of objective measures of body composition to predict cIMT. Methods cIMT was assessed on the common carotid artery in 349 children aged 11–12 years old (183 girls). Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were dichotomized according to established criteria and indices of total body (TBFI) and abdominal (ABFMI) fat were assessed by dual-energy X-ray absorptiometry and categorized (increased risk ≥85%). Single and combined associations among anthropometric and laboratorial measures with the risk of having increased cIMT (≥85%) and discriminatory performance were tested with logistic regression analysis and Receiver Operator Curve analysis. Results Children with higher total fatness (BMI and TBFI) or higher central pattern of fat accumulation (WC, WHtR and BFMI) were in higher risk for increased cIMT [odds ratio (OR): 2.08–3.24). The risk for increased cIMT was not higher among children who coupled high total and high central fatness (OR: 2.27–3.10). Conclusions Combination of total and central measures of fat does not improve the prediction of increased cIMT in children. Simple surrogate measures of fatness can be used to predict increased cIMT urging special attention to those children who exhibit increased abdominal fat.

Background:It is unclear how sedentary behavior (SED), physical activity (PA), and cardiorespiratory fitness (CRF) influence vascular structure in children of varying body size. This study examined whether associations between SED, PA, and CRF with intima-media thickness (IMT) added to that of abdominal fatness and IMT. Differences in physiological measures among waist circumference (WC) percentiles were tested.Methods:We assessed IMT of the carotid artery in 265 children aged 11 to 13 years (135 girls). Measures included IMT assessed with high-resolution ultrasonography, WC, body fat mass (BFM) from DXA, and CRF determined using a maximal cycle test. SED and PA were assessed by accelerometry. Association between IMT and CRF adjusted for PA variables, and body composition phenotypes were tested with multiple linear regression analysis.Results:CRF was related to IMT independently of moderate to vigorous PA (MVPA) and SED (P < .05). When WC was added to the model CRF was no longer associated with IMT (P > .05). Children in the higher WC group had increased mean values of BMI, BFM, WC, and IMT and lower MVPA and CRF (P < .05).Conclusion:Full modeling of SED, MVPA, CRF, and WC revealed that regional adiposity appears to have the biggest role in arterial structure of children.

Early detection of impairment in vascular structure is an important clinical pursuit. However, it is unknown which measure of body composition best predicts vascular wall changes. We assess the differences in body composition among intima-media thickness (IMT) tertiles and determined which measures of body composition are associated with IMT in 385 children aged 11–13 years (196 girls). In this cross-sectional study, body mass index (BMI), waist circumference (WC), body fat mass (BFM), and trunk fat mass (TFM) from dual-energy radiographic absorptiometry and IMT through high-resolution ultrasonography were collected. Differences in body composition measures among IMT tertiles [low IMT (LIMT), ≤0.46 mm; middle IMT, 0.46–0.53 mm; higher IMT (HIMT), ≥0.53 mm] were assessed with ANOVA/ANCOVA after categorization. Regression analysis was used to assess the relationships between body composition and IMT. The groups were similar for sex, age, and maturity (p > 0.05). As compared with LIMT group, subjects with HIMT had higher mean values of BMI, BFM, TFM, and WC (p

Dissertação apresentada à Escola Superior de Tecnologia do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Infra-Estruturas de Construção Civil. A Ribeira da Pracana é um importante afluente do Rio Ocreza. O Rio Ocreza, localizado no centro de Portugal tem origem numa importante serra chamada Serra da Gardunha. Inicia-se a 1160 metros de altitude e estende-se por 80 km até desaguar no Rio Tejo. Contempla várias ribeiras e afluentes ao longo dos quais existem várias aldeias rurais. As águas da Ribeira da Pracana têm um papel importante por ser abundantemente utilizada na agricultura, a principal actividade económica dessas comunidades, e para o consumo humano. É de crucial importância caracterizar, monitorizar e controlar o impacte das descargas das Estações de Tratamento de Águas Residuais, na qualidade da água. Este estudo centra-se na Estação de Tratamento de Águas Residuais de Proença-a-Nova, que descarrega directamente na Ribeira da Freixada, um afluente da Ribeira da Pracana. Foram recolhidas doze amostras de água, georreferenciadas, entre o ponto de descarga de efluentes residuais e a confluência com a Ribeira da Pracana. A jusante, foram identificadas entradas secundárias e recolhidas amostras de água em distâncias aproximadamente iguais. Foram realizadas campanhas de amostragem durante três épocas distintas ao longo do ano hidrológico de 2009/2010: inverno chuvoso (Janeiro), condições temperadas (Março) e estação seca (Junho). Os parâmetros químicos analisados foram: a carência bioquímica de oxigénio (CBO5), a carência química de oxigénio (CQO), a concentração de oxigénio dissolvido (OD), o resíduo seco, o Fósforo Total (Ptotal), o Azoto Total (Ntotal), o pH, a temperatura e parâmetros microbiológicos. A concentração de oxigénio dissolvido (OD), a carência bioquímica de oxigénio (CBO5) e os parâmetros microbiológicos foram usados como indicadores da presença de matéria orgânica no corpo de água, e como parâmetros para avaliar a poluição ambiental. Foi realizada uma simulação para a qualidade da água na Ribeira da Pracana pela aplicação de um modelo hidrodinâmico de dispersão de água. Este modelo de qualidade da água foi construído recorrendo ao software QUAL2Kw. The Pracana River is an important tributary of the Ocreza River. The Ocreza River is located in Central Portugal and has it source in an important Alpine chain called Gardunha. It starts at 1160 m altitude and stretches for 80 km until draining into the Tagus River. It has several creeks and tributaries along which there are several rural villages. The Pracana's waters has an important role by being abundantly used in agriculture, the main economic activity of these communities, and for human consumption. Characterization, monitoring and control of the impact due to several Wastewaters Treatment Plant discharges on water quality is of crucial importance. This study focuses on the Proença-a-Nova Wastewater Treatment Plant, which discharges directly into the Freixada River, a Pracana’s tributary. Twelve georeferenced water samples were collected between the sewage effluent discharge and the Pracana river confluence. Secondary inflows were identified and water samples collected downstream at approximately equal distances. Sampling campaigns were conducted during three different hydrological periods in 2009/2010: rainy winter (January), intermediate conditions (March) and dry season (June). The following chemical parameters were analyzed: biochemical oxygen demand (BOD5), chemical oxygen demand (COD), dissolved oxygen concentration (DO), dry residue, total phosphorus (Ptotal), total nitrogen (Ntotal), pH, temperature and microbiological parameters. The dissolved oxygen concentration (DO), biochemical oxygen demand (BOD5) and the microbiological parameters were used as indicators for the presence of organic matter in the body of water, and as parameters for evaluating the environmental pollution. The simulation for the water quality in the Pracana river was performed by a coupled hydrodynamic and water dispersion model. The water quality model was constructed applying to QUAL2kw software.

The aim of this investigation was to analyze differences in body composition and body fat distribution between subjects following a structured cardiac rehabilitation program (CRP) and subjects not involved in any CRP.Body composition and body fat distribution were assessed by dual-energy X-ray absorptiometry (DXA) in 62 male subjects, white, who had been diagnosed with coronary artery disease (CAD). The sample came from two groups: a CRP group (n=31) who had been engaged in phase IV of a CRP for more than a year (age: 58 +/- 10 years), and a non-CRP group (n=31) who were not involved in any CRP (age: 59 +/- 12 years).The non-CRP group showed higher values than the CRP group in the following variables: body weight (84.924 +/- 11.250 kg vs. 79.077 +/- 10.050 kg, p0.05), BMI (29.0 +/- 3.2 kg/m2 vs. 27.3 +/- 2.6 kg/m2, p0.05), body fat (BF) (24.584 +/- 6.696 kg vs. 20.010 +/- 7.340 kg, p0.05), % BF (28.6 +/- 4.9% vs. 24.7 +/- 6.7%, p0.05), trunk BF (14.563 +/- 4.408 kg vs. 11.430 +/- 4.743 kg, p0.01), % trunk BF (32.8 +/- 6.0% vs. 27.4 +/- 8.5%, p0.01), abdominal BF (2.934 +/- 1.068 kg vs. 2.083 +/- 1.058 kg, p0.01), % abdominal BF (37.2 +/- 6.1% vs. 31.3 +/- 9.4%, p0.01), visceral BF (2.401 +/- 0.693 kg vs. 1.731 +/- 0.826 kg, p0.01), % visceral BF (35.5 +/- 5.7% vs. 29.6 +/- 9.1%, p0.01), abdominal subcutaneous BF (0.533 +/- 0.421 kg vs. 0.353 +/- 0.257 kg, p = 0.05) and abdominal BF/BF ratio (0.12 +/- 0.03 vs. 0.10 +/- 0.02, p0.05). There were no significant differences in the other variables studied, including total and regional fat-free mass.These results show that the subjects who did not participate in any CRP had a more adverse profile of body composition and body fat distribution. The higher values found for specific fat depots, as well as for the total abdominal BF/BF ratio, confirm the more adverse body fat distribution in non-CRP subjects. These data are in agreement with results from intervention studies in CAD patients.

O objectivo desta investigação foi analisar a composição corporal e a distribuição de gordura corporal de sujeitos com doença das artérias coronárias (DAC) envolvidos num programa estruturado de reabilitação cardíaca (PRC) e sujeitos com DAC que não participam em qualquer PRC. População e métodos: A amostra foi constituída por 62 sujeitos do sexo masculino, caucasianos, com DAC diagnosticada, oriundos de cada um de dois grupos estudados: grupo C/PRC (n=31) foi constituído por sujeitos que participavam na fase IV de um PRC há mais de um ano (idade: 58 + 10 anos); grupo S/PRC (n=31) foi constituído por sujeitos que não participavam em qualquer PRC (idade: 59 + 12 anos). Foi observada a composição corporal e distribuição de gordura corporal dos sujeitos da amostra, através da análise por Densitometria por Raio-X de Dupla Energia (DXA). Foram recolhidas medidas antropometricas. Resultados principais: sujeitos que não participaram em qualquer PRC apresentaram valores superiores, aos sujeitos do grupo C/PRC, nas variáveis massa corporal total (p 30 kg/m2) no grupo S/PRC (p