HEALTHY WEIGHT LOSS MAINTENANCE WITH EXERCISE, LIRAGLUTIDE, OR BOTH COMBINED

  • Weight regain after weight loss is a major problem in the treatment of persons with obesity.
  • The occurrence of obesity is greater than ever, with unfavorable effects on health and increases the risk of death. Many patients have preliminary weight loss, but weight regain frequently occurs unless a structured weight-maintenance program is followed. Rapid weight regain may be due to a decline in total energy expenditure, beyond that predicted from the loss of lean and fat mass, and to increased appetite.
  • A lessen in body weight of 3 to 5% has been related with decreased  obesity-related risk factors, while a larger weight loss of above 5 to 15% of the preliminary body weight is suggested for patients with coexisting conditions, morbid obesity, or both.
  • Structured aerobic exercise programs increase energy expenditure and cardiorespiratory fitness although reducing fat mass and preserving or increasing lean mass. Diet management programs, including the use of low-calorie meal alternate products, can sustain low-calorie diet–induced weight loss with a small weight regain. In addition, lifestyle interventions that promote increased physical activity concurrent with calorie restriction have been shown to sustain moderate weight loss.
  • Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is used in the treatment of obesity because it induces weight loss and maintains low-calorie diet–induced weight loss for at least 1 year, mainly by means of appetite inhibition.
  • Whether exercise, medication, or a combination strategy constitutes the extra effective approach for maintaining healthy weight loss . The study investigated the efficacy of 1-year treatment with a moderateto-vigorous–intensity exercise program, liraglutide at a dose of 3.0 mg per day, or the combination of exercise plus liraglutide, as compared with placebo, for healthy weight loss maintenance after weight loss induced by a low-calorie diet.
  • The exercise program was designed to meet the World Health Organization (WHO) recommendations on physical activity for health of a minimum of 150 minutes per week of moderate-intensity aerobic physical activity, or 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of both. After an initial 6-week rampup phase, participants were encouraged to attend supervised group exercise sessions (which involved 30 minutes of vigorous-intensity, interval-based indoor cycling and 15 minutes of circuit training) two times per week and to perform moderate-tovigorous–intensity exercise individually (which mostly involved outdoor or indoor cycling, running, or brisk walking) two times per week.
  • Liraglutide (at a concentration of 6 mg per milliliter) or volume-matched placebo was injected subcutaneously, starting at a dose of 0.6 mg per day, with supervised weekly increments of 0.6 mg per day; the dose was intended to eventually reach 3.0 mg per day.
  • During the 8-week low-calorie diet, the participants’ body weight decreased by a mean of 13.1 kg, which was equivalent to a mean reduction in body weight of 12%. This decrease was accompanied by decreases in the body-fat percentage, waist circumference, waist-to-hip ratio, glycated hemoglobin level, blood pressure, lipid levels, resting heart rate, and HOMA-IR. The Matsuda index, cardiorespiratory fitness, general health perception, physical functioning, and emotional well-being increased.
  • After the low-calorie diet, the participants’ body weight decreased further by a mean of −3.4 kg in the combination group but increased by a mean of 6.1 kg in the placebo group, resulting in a treatment difference of −9.5 kg. The initial weight loss was maintained in the exercise group, with a treatment effect as compared with placebo of −4.1 kg. Liraglutide treatment also resulted in maintenance of the initial weight loss, with a treatment effect as compared with placebo of −6.8 kg. In the combination group, the treatment effect as compared with exercise was −5.4 kg and the treatment effect as compared with liraglutide was −2.7 kg.
  • All active treatments (i.e., those involving exercise, liraglutide treatment, or both) were associated with decreases in fat mass and waist circumference, as compared with increases in the placebo group, and the decreases were twice as large in the combination group as in the other groups. Exercise was associated with increased lean mass. Exercise and the combination strategy were associated with increased cardiorespiratory fitness, which was not observed with placebo or liraglutide . Liraglutide treatment and the combination strategy were associated with reductions in the glycated hemoglobin level, as compared with an increase in the placebo group. Only the combination strategy was associated with reductions in the HOMA-IR and the waist-to-hip ratio and with increases in the Matsuda index and in physical functioning, as compared with placebo. All active treatments were associated with maintained reductions in the systolic and diastolic blood pressures, which were not observed with placebo. Exercise and the combination strategy were associated with maintenance of the initial improvements in general health perception and emotional wellbeing, which were not observed with placebo or liraglutide.
  • Adverse events that occurred in at least 10% of all participants, urinary tract infections, palpitations, and all serious adverse events are reported. Few participants which are receiving liraglutide and placebo discontinued taking liraglutide or placebo because of adverse events. Gastrointestinal adverse events, decreased appetite, and dizziness were more frequently reported in the groups that received liraglutide (i.e., in the liraglutide group and combination group) than in the other two groups. Cholelithiasis as a serious adverse event and palpitations were reported more frequently in the liraglutide group than in the combination group. After 1 year, liraglutide treatment alone was associated with an increased resting heart rate; this finding was not observed with the combination strategy. The incidence of other adverse events was similar among the trial groups.
  • In this randomized, head-to-head, placebo-controlled trial, Investigated that exercise, liraglutide, and both treatments combined for healthy weight loss maintenance. All active-treatment groups decreased body weight and body-fat percentage after 1 year, as compared with the increases observed in the placebo group. The combined strategy reduced the body weight and body-fat percentage approximately twice as much as the single-treatment strategies did and was associated with additional health benefits, such as improvements in the glycated hemoglobin level, insulin sensitivity, cardiorespiratory fitness, physical functioning, and emotional well-being.

THE INFLUENCE OF SMARTPHONE USE ON SPINAL POSTURE

  • Smart phones have become increasingly more popular and complicated tasks can be performed with these devices. However, the increasing use is associated with shoulder and neck pain, as well as with psycho-logical addiction.
  • Over the last years smart phones have gotten increasingly popular, since they can perform complicated tasks such as internet access, social networking, and Smartphone applications.
  • According to the study currently 45.12 % of the world’s population has a smart-phone.
  • Smartphone users spend more than 20 h per week on texting, emailing, and using social networks, which represents a significant dependence on smart phones for connecting and communicating with others
  • The high use of smart phones has increase negative influences on safety and health, including mental and musculoskeletal health. In particular, using smart phones for daily tasks by a combination of internet use and mobile calls can lead to Smartphone addiction. The overuse of smartphone affects the upper extremity pain, anxiety, depression, and interpersonal relationships. They found that anxiety and depression were more common. Increased smartphone use can also lead to an increased non-neutral posture and sustained muscle loading. Increased smartphone use can lead to musculoskeletal pain, which can be found in 1–67.8 % of all smartphone users, with neck pain being the most prevalent.
  • The prevalence of Smartphone addiction is reported to be around 8.4–24.9 % in adolescents. Adults between the ages of 18–24 years use their smartphones for 980 call minutes and for 1200 text messages per month.
  • The human spine is linked in a kinematic chain of joints, meaning that changes in other body segments, such as increased head flexion during texting with a smartphone, can have significant effects on the whole spine. Smartphone use leads to a significant increase in the head flexion angle, and that this increase may depend on the respective smartphone task. An increased head flexion angle requires higher contraction forces of the neck extensor muscles in order to support the head in a more flexed position, which has been identified as a risk factor for head and neck pain.
  • Smartphones are a detrimental part of our daily lives, however overuse can be associated with physical and psychological problems. smartphone tasks lead to significant changes in the spinal posture such as increased thoracic kyphosis and trunk inclination during standing and while walking. It was demonstrated that smartphone use can also lead to significant changes in the lumbar lordosis and in the rotation of the spine, as measured by the surface rotation.

DOES VITAMIN D BENEFIT ONLY THOSE WHO ARE DEFICIENT?

Vitamin   D   is   an   essential   nutrient   obtained   from   sunlight, dietary intake, and supplementation.  Obser­vational   epidemiological   studies   have   consistently   found that low concentrations of circulating 25­hydro x y­      vitamin  D  (25[OH]D),  a  metabolite  used  as  a  clinical  indicator  of  vitamin  D  status,  are  associated  with  an  increased  risk  of  cardiovascular  disease  and  all­cause  mortality,  as  well  as  other  chronic  diseases.

The randomised trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings.  However,  generalisability  of  results  to  individuals  with  low  vitamin  D  status  is  unclear.   The study is to  characterize   dose-response   relationships   between   25-hydroxy vitamin   D   (25[OH]D)   concentrations  and  risk  of  coronary  heart  disease,  stroke,  and  all-cause  mortality  in  observational  and  Mendelian  randomisation frameworks.

  • There is a significant inverse relationship between concentrations of circulating 25­-hydroxy­-vitamin D (25[OH]D) and all-cause mortality, but only in people with vitamin D35 studies showed that, overall, there is no significant relationship between 25(OH)D concentrations, a clinical indicator of vitamin D status, and the incidence of coronary heart disease (CHD), stroke, or all-cause death.
  • In vitamin D deficient individuals, each 10 nmol/L increase in 25(OH)D concentrations reduced the risk of all-cause mortality by 31%.(Stephen Burgess, PhD)
  • There was a non-significant link between 25(OH)D concentrations and stroke and CHD, but again, only in vitamin D deficient individuals. (Research, published in The Lancet Diabetes & Endocrinology)
  • The result of the study an accompanying editorial, Guillaume Butler-LaPorte, MD, and J. Brent Richards, MD, “could have important public health and clinical consequences” and will “allow clinicians to better weigh the potential benefits of supplementation against its risk,” such as financial cost, “for better patient care — particularly among those with frank vitamin D deficiency.”
  • “Given that vitamin D deficiency is relatively common and vitamin D supplementation is safe, the rationale exists to test the effect of vitamin D supplementation in those with deficiency in large-scale randomized controlled trials.”
  • The team gathered data from the UK Biobank, the European Prospective Investigation Into Cancer and Nutrition Cardiovascular Disease (EPIC-­CVD) study, 31 studies from the Vitamin D Studies Collaboration (VitDSC), and two Copenhagen population­-based studies.
  • They first performed an observational study that included 384,721 individuals from the UK Biobank and 26,336 from EPIC-­CVD who had a valid 25(OH)D measurement and no previously known cardio­vascular disease at baseline.
  • Researchers also included 67,992 participants from the VitDSC studies who did not have previously known cardiovascular disease. They analyzed 25(OH)D concentrations, conventional cardiovascular risk factors, and major incident cardiovascular morbidity and mortality using individual participant data.
  • The results showed that, at low 25(OH)D concentrations, there was an inverse association between 25(OH)D and incident CHD, stroke, and all-cause mortality.

Up to 7% of Study Participants Were Vitamin D Deficient

  • The 25(OH)D analysis indicated that 3.9% of UK Biobank and 3.7% of Copenhagen study participants were deficient, compared with 6.9% in EPIC-CVD.
  • Across the full range of 25(OH)D concentrations, there was no significant association between genetically­ predicted 25(OH)D levels and CHD, stroke, or all­-cause mortality.
  • The genetic variants may affect 25(OH)D concentrations in a different way from “dietary supplementation or other clinical interventions.”