The role of physical activity and exercise in obesity and weight management: Time for critical appraisal

The prevalence of overweight and obesity has increased dramatically during last 3 decades with devastating consequences to public health. Recommended strategies to reduce obesity have focused on healthier diet and physical activity （PA）. Clearly, these approaches have not been successful, but whether this is due to failure to restrict energy intake or to maintain high levels of energy expenditure has been the subject of great controversy. Consequently, there has been a great deal of confusion about the role of PA and exercise in obesity and weight management. In this article, the theoretical basis for considering reduced PA and energy expenditure as the cause of obesity is appraised. Further, the role of PA in food intake and weight control is examined. The idea that obesity is caused by consistent deeline in daily energy expenditure is not supported either by objective measures of energy expenditure or physiological theory of weight gain alone. However, since voluntary exercise is the most important discretionary component of total daily energy expenditure, it can affect energy balance. Therefore, PA and exercise hold potential as part of the solution for the ongoing obesity epidemic.

2024 Adult Compendium of Physical Activities:A third update of the energy costs of human activities

Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

Weekly Physical Activity from IPAQ (Arabic) Recalls and from IDEEA Activity Meters

Objective: Determine the Test reliability and the objective validity of the International Physical Activity Questionnaire (IPAQ). Methods: IPAQ was evaluated for test-retest reliability within 6 - 8 days of its first administration. Criterion validity was tested comparing IPAQ data with those from an activity meter (Intelligent Device for Energy Expenditure and Activity, IDEEA). Results: The test-retest correlation (n = 71) for items of IPAQ ranged from r = 0.63 to r = 0.74 and was r = 0.79 for the total weekly PA in MET*min per week. Average PA (in MET*min/week) measured with the IDEEA meter, decreased from normal (15,840), to 14,278 in overweight (BMI > 25- < 30) and further to 12,803 in obese subjects (>30. BMI). The weekly energy expenditure measured by IDEEA correlated significantly (r = 0.61, r2 = 0.38) with the IPAQ data, providing an objective criterion for validity of IPAQ. The mean values of weekly PA estimated from IPAQ (in MET*min/week) differed significantly in the high (15,690) vs. the low (11,398) activity groups but not between the moderate (12,056) compared to the low PA group. The IPAQ criteria used to categorize subjects as moderately active, erred by including too many low PA subjects. IDEEA measurements in sedentary subjects overestimated their energy expenditure. Conclusions: IPAQ can be reliably used to distinguish low and high PA groups and yields relatively low estimates (−18%) of weekly PA in these groups compared to those measured with the activity meter. Stricter criteria are needed to distinguish moderate from low PA groups. Overweight and obese subjects showed significantly lower levels of PA than normal BMI subjects. IDEEA overestimates low levels of PA.

Is Non-exercise Activity Thermogenesis-a Target for Reversing Obesity?

Non-exercise activity thermogenesis (NEAT) is the energy expenditure of all physical activities other than volitional sporting-like exercise. NEAT includes all the activities that render us vibrant, unique and independent beings such as working, playing, and dancing. Because people of the same weight have markedly variable activity levels, it is not surprising that NEAT varies substantially between people by 2000 kcal/day. Evidence suggests that low NEAT may occur in obesity but in a very specific fashion. Obese individuals appear to exhibit an innate tendency to be seated for 2.5 hours per day more than sedentary lean counterparts. If obese individuals were to adopt the lean ‘NEAT-o-type’, they could potentially expend an additional 350 kcal/day. Obesity was rare a century ago and the human genotype has not changed over that time. Thus, the obesity epidemic may reflect the emergence of a chair-enticing environment to which those with an innate tendency to sit, did so and became obese. To reverse obesity therefore, we need to develop individual strategies to promote standing & ambulating time by 2.5 hours per day but also re-engineer our work, school and home environments to render active living the option of choice.

Association between physical activity energy expenditure and cardiometabolic risk factor clustering among Chinese adults in 2015

To understand the association between cardiometabolic risk factor(CMRF)clustering and physical activity(PA)levels,we included 86520 Chinese adults aged 18–64 years having at least one CMRF(hypertension,diabetes,dyslipidemia,or obesity)from the China Chronic Disease and Nutrition Surveillance survey in 2015,a nationally and provincially representative investigation with a multistage clustering sampling design.Self-reported PA information was collected with the Global Physical Activity Questionnaire through face-to-face interviews.In view of the obesity epidemic in CMRF patients,PA energy expenditure(PAEE)per kilogram body weight was used,and was defined into four categories:(i)inactivity:0 kJ/kg/day;(ii)low activity:0–5 kJ/kg/day;(iii)moderate activity:6–11 kJ/kg/day;and(iv)vigorous activity:≥12 kJ/kg/day.The estimated weighted prevalence(95%confidence interval[CI])of having 1,2,3,and 4 CMRFs was 60.57%(59.48%–61.67%),28.10%(27.40%–28.79%),9.82%(9.22%–15.42%)and 1.50%(1.37%–1.63%),respectively.The rate(95%CI)of inactivity,low activity,moderate activity,and vigorous activity was 34.52%(32.69%–36.35%),22.22%(21.37%–23.37%),15.98%(15.38%–16.58%)and 27.28%(26.02%–28.53%),respectively.For those having 2,3 and 4 CMRFs(compared to those having 1 CMRF),the adjusted odds ratio(95%CI)for moderate activity and vigorous activity were 0.91(0.85–0.98)and 0.92(0.85–0.99),0.87(0.80–0.95)and 0.84(0.77–0.92),and 0.77(0.67–0.89)and 0.85(0.72–1.00),respectively.In conclusion,CMRF clustering was a pandemic among Chinese adults in 2015 and was inversely associated with PA level.PAEE(in kJ/kg/day)may be introduced into PA management practice,especially for populations with high body weight.

《身体活动汇编》(Compendium of Physical Activities):内容、应用与发展

身体活动(physical activity,PA)不足被世界卫生组织认定为全球第四大死亡风险因素,如何应对PA不足是21世纪公共健康领域的一个重要议题,其中,测量、监控、评估PA的能量消耗和强度是寻求“解决之道”的关键环节之一。《身体活动汇编》(Compendium of Physical Activities,CPA)对PA能量消耗进行评估和分类,其由美国Barbara Ainsworth等编创。CPA自1993年发布后,在国外得到广泛认可和应用,并于2000年和2011年进行了2次更新,但其在国内的知晓度、应用率不高,且存在汉语翻译不统一、运用不灵活的现象。为此,在其原版主要创始人Barbara Ainsworth的授权下,笔者翻译了2011年版,完成了《身体活动汇编(汉英对照版)》,并对Barbara Ainsworth进行了采访,全面介绍和阐述CPA的发展历程、主要内容、汉语翻译、情境应用与未来发展,推广这一可直接量化PA能量消耗的工具,规范其汉语翻译,提高其知晓度,并鼓励相关人员使用,提升其应用率和使用灵活度,进而推进我国PA研究与实践的发展。

Assessment of physical stress during the perioperative period of endoscopic submucosal dissection

The advantage of endoscopic submucosal dissection(ESD)is that it is less invasive than surgery.ESD is one of the best treatments for older patients as surgery in this age group of patients is difficult.However,it is unclear how much lower the physical stress of ESD is compared with that of surgery.Thus,objective methods are required to assess physical stress in patients who have undergone ESD.The current review of ESD aimed to summarize the recent advancements in the assessment of physical stress during the perioperative period,focusing on changes in energy metabolism and serum opsonic activity(SOA).Based on metabolic changes,resting energy expenditure(REE)was measured using an indirect calorimeter.The stress factor calculated from the REE and the basal energy expenditure computed using the Harris-Benedict equation can be used to assess physical stress.SOA was assessed using the chemiluminescence method,wherein the use of chemiluminescent probes(i.e.,lucigenin and luminol)allowed quantification of reactive oxygen species generated by neutrophils.Using an auto luminescence analyzer,the results were evaluated based on the maximum light emission and area under the emission curve.These quantifiable results revealed the minimal invasiveness of ESD.

In Accordance with Governmental Recommendations--A Study of Golf and Health

Norwegian authorities recommend that adults and elderly people be physically active for at least 30 min every day at moderate to high levels of intensity. This is equivalent to approximately 10,000 steps a day. This research study seeks to determine whether golf is beneficial to individual health as defined by the governmental recommendations. The study included 29 participants, whose heart rate, playing time, and walked distance were measured as they carried a GPS （global position system） receiver. Male players walked on average 11,256 ＋ 830 m while female players walked on average 10,000 ~ 595 m. Thus, men tended to walk 1.98 times the course length while women walked 2.13 times the course length. The duration of the golf round averaged 269 ~ 25.4 rain （i.e., 4 h 29 min）; for men, the mean duration was 271 rain, and for women, it was 267 rain. The average heart rate was 104.1 ~ 14.5 bpm for male players and 110.8 ~ 16.9 bpm for the female players. Based on the energy expenditure in kcal on the golf course, male players used 2,467 kcal on average while female players used 1,587 kcal on average during a round of golf. Comparing the hilliness of two different golf courses, it indicated that golf playing could be a form of interval training. Our results strongly indicate that golf is beneficial to health as defined in the governmental recommendations.

Energy Expenditure of Adolescents During Overground Walking and Running

This study aimed to determine the net energy expenditure(EENET)required for overground walking and running 1200 m in a sample of healthy adolescent boys and girls.A secondary purpose was to describe the effect of body composition on energy expenditure(EE)of walking versus running.Twenty healthy adolescents(9 boys,11 girls)aged 15.85±2.80 years performed 2 field tests in regular outdoor conditions:overground walking(1.64±0.17 m/s)and submaximal running(3.13±0.42 m/s),at a self-selected steady pace.EE was measured via indirect calorimetry.Paired sample t-tests were used to determine if there were differences between walking and running conditions and mean percentage differences were estimated for various physiological parameters.Differences in EENET between conditions were performed for both genders using a two(condition)by two(gender)analysis of variance repeated measures design,with fat free mass as a covariate.Speed increased by 90.43%between the 2 conditions,while the different components of EE increased by almost 20%.Running elicited a significantly greater EENET than walking for both genders;however,boys’and girls’EE did not differ significantly.When EENET was adjusted for fat free mass,there was a statistically significant condition×fat free mass effect.The findings in this study indicate that both adolescent boys and girls expend more energy during running than walking,without being affected by body composition.Body mass and fat free mass significantly correlated with EE only during running.In addition,the trained participants of the study optimized locomotion to minimize EE.

步行和日常体力活动能量消耗的推算

目的:研究不同步速下行走时的能量消耗水平,进而推导出根据计步器参数推算步行能耗和一日总能耗的方程,以期为进一步开发计步器功能提供参考依据。方法:研究对象为在校大学生共计30名(男性15名,女性15名)。受试者身体右侧平肚脐锁骨中线处和腋前线交点处分别佩带计步器,在跑台上分别以3.2、4.8、6.4、8.1、9.7 km/h 5种速度步行800 m,记录计步器计数和实际步数,通过间接热量法测试步行代谢情况。佩带计步器一周,记录每日计步器计数,每日填写Bouchard体力活动日记。结论:以不低于正常步速行走时,计步器可以精确记录步数,放置位置不同对步数记录无影响。随着速度加快,步频加快,步幅加大,单位能耗增加。但在完成相同距离步行时,运动强度(速度)不同,总热量消耗不完全一致,能量消耗不仅与单位能耗有关,运动时间也是重要的因素。根据计步器参数推算步行能量消耗和一日总能量消耗的公式分别为:步行能量消耗(kca l)=0.43×身高(cm)+0.57×体重(kg)+0.26×步频(步/m in)+0.92×时间(m in)-108.44。一日能量消耗(kca l)=0.05×一日计步器计数(步)+2213.09×体表面积(m2)-1993.57。

量化评估早期系统康复对全膝关节置换患者步态的影响

目的:利用便携式步态分析仪(intelligent device for energy expenditure and physical activity,IDEEA)对全膝关节置换(total knee arthroplasty,TKA)患者的步态参数变化及特点进行测量,量化评估系统康复训练对TKA患者的康复效果,并对康复治疗方案的改进提供一定参考价值。方法:将符合纳入标准的单侧膝骨关节炎(knee osteoarthritis,KOA)患者74例随机分为试验组与对照组。对照组接受骨科术后常规康复治疗,试验组接受系统化康复训练。分别于术前及术后第12周进行西安大略及麦克马斯特大学骨关节炎指数评分(Western Ontario and Mc Master University Osteoarthritis index,WOMAC)、美国特种外科医院膝关节评分(The hospital for special surgery knee score,HSS)、膝关节活动度测量及步态分析。结果:术后12周试验组患者在WOMAC评分、HSS评分及膝关节活动度方面明显优于对照组。试验组手术侧肢体摆动强度、蹬地强度、跖屈强度、步速、步频、步长、步幅在行系统康复后较对照组有明显改善。结论:术后12周系统康复可明显减轻TKA患者膝关节疼痛,改善下肢功能;IDEEA可客观评估TKA患者康复治疗前后的步态参数,对康复治疗方案的改进提供一定参考价值。

4种运动传感器测量身体活动能耗的有效性研究

Actigraph(GT3X)加速度计、LivePod iMate能耗仪、AM-120与HJ-302计步器均应用了三维运动传感技术,可用于日常身体活动与运动能耗的监测。以我国的年轻成人为受试对象,年龄为(24±5)岁,包括14名男性与6名女性。受试者佩戴4个运动装置的同时,在运动跑台上分别完成4、5.6、6.4、7.2、8 km/h不同强度的走跑运动各5 min。以间接测热法的能耗值作为效标,采用Pearson相关、单因素方差以及配对T检验等分析方法,对4种运动传感器进行效度研究。结果发现:Actigraph加速度计的能耗值以低估为主,但在不同运动强度上有较低的系统误差水平;LivePod iMate能耗仪与HJ-302计步器也以低估为主,但前者随运动强度增大低估水平增加,后者则相反;AM-120计步器在6.4 km/h速度以下低估,7.2 km/h时开始变为高估。结论认为,GT3X加速度计具有较高的效度水平,而其他3种运动传感器系统误差较大,应用时可依据需要进行选择。

体力活动研究中加速度计的应用

加速度计在体力活动研究中的应用很广泛,对多个品牌加速度计的性能特点、研究应用进行了综述。建立在不同运动方式基础上的能量推算方程精度差别比较大,各种方程也都有其适合应用的范围。复杂的分段方程和非线性方程提高了推算精度,但其在研究中的应用效果还有待验证。在选择加速度计和相关的方程时要把研究设计的要求和加速度计的性能特点加以综合考虑。

大学生不同体力活动能量消耗和运动效率的研究

目的:研究大学生不同体力活动能量消耗及运动效率。方法:通过问卷调查、体格检查及血液检查,筛选出从事轻体力活动的健康大学生49名,男性25名,女性24名,采用K4b2便携式心肺功能测定仪测量其进行不同体力活动(慢走、快走、慢跑、骑自行车)时的耗氧量和二氧化碳生成量,用凯式定氮法测量24小时尿氮,利用Weir公式计算能量消耗量。根据能量消耗量(kJ/h/kg)和不同运动形式的运动速度(km/h),计算单位体重单位距离能量消耗值(J/m/kg)来表征运动效率,此值越高,运动效率越低。结果:体力活动平均能量消耗量:慢走12.11±1.84,快走19.00±2.60,慢跑32.99±4.90,骑自行车16.43±2.68;运动效率表征值:慢走3.03±0.47,快走3.17±0.43,慢跑4.12±0.61,骑自行车1.37±0.22;骑车运动效率最高,慢跑最低,慢走与快走的差异无统计学意义。结论:控制体重除参考能量消耗,还可考虑运动效率选择适宜个体的运动方式。

智能能量消耗和日常活动记录仪对腰部活动执行能力定量评估的信度研究

目的:探讨智能能量消耗和日常活动记录仪(IDEEA)的信度和敏感性,为临床应用提供客观评估依据。方法:30例正常人和30例腰椎间盘突出症患者,1周内采用IDEEA对每例测试对象进行2次测试。结果:两次测试结果各指标高度相关(ICC=0.914—0.997),病例组与对照组各个测试指标中前屈运动时间(TFF)、前屈最大角度(MFA),前屈运动速度(FAV)差异有显著性(P<0.01)。结论:IDEEA用于评定正常人和腰椎间盘突出症状患者的腰部活动执行功能具有较高的信度和敏感性。

中老年肥胖男性身体活动水平与能量消耗特征

以中老年男性肥胖人群为对象,同正常体重人群相比,研究肥胖人群自由生活下的身体活动水平、静息代谢、特定活动下的能耗代谢率、能源底物利用特征,为肥胖机制研究和干预措施制定提供参考。方法：14名50~60岁肥胖男性者（BMI〉30）和15名体重正常者（BMI=23）使用加速度计RT3连续7天测量身体活动。之后使用Cortex MetaMax 3 B进行静息代谢和特定身体活动能耗的测量（坐、站、步行3.2 km/h,4.8 km/h,6.4 km/h）。结果：1）肥胖者的每日总能耗、身体活动能耗、中等强度以上活动能耗、中等以上活动的累计时间都显著大于对照组（P〈0.05）。调整了体重因素后,肥胖者单位体重每日能耗/kg略低于对照组,而单位体重身体活动能耗显著高于对照组。2）肥胖组静息能耗高于体重正常组,若是以单位体重计算,静息代谢率显著低于体重正常组（P〈0.05）。3）在坐、站、走活动中,肥胖组消耗的能量显著高于对照组（P〈0.05）。若以公斤体重计算能耗,肥胖组坐姿和站姿的相对能耗略低于对照组,步行的相对能耗两组无差别。4）相同运动下两组人群安静平卧、坐、站、3.2 km/h和4.8 km/h步行时的呼吸交换率没有差异。6.4 km/h步行时,肥胖组的呼吸交换率显著高于体重正常组（P〈0.05）。5）用回归统计法分析影响肥胖的危险因素,静息代谢率可以作为预测肥胖的因子。结论：肥胖人群的身体活动量和每日消耗能量不低于体重正常组,造成肥胖的原因很可能与能量消耗有关,较低的静息代谢率是肥胖发生的重要因素。此外,运动中脂肪氧化能力下降也可能是肥胖危险因素。

智能能量和日常活动记录仪在动态评估腰椎间盘突出症患者运动功能中的应用

目的观察智能能量和日常活动记录仪(IDEEA)动态定量评估腰椎间盘突出症(PID)患者运动功能的临床意义。方法将8例确诊为PID的患者设为研究组,同时选择年龄、身高、体重与之匹配的健康志愿者9名为对照组。采用IDEEA测试系统监测两组受试者日常生活活动,应用IDEEA相关软件采集身体运动功能相关数据并进行统计分析。结果研究组腰部前屈速度、前屈完成时间、坐-站时间、站-坐时间与对照组均有显著性差异(P<0.05)。步态分析显示,研究组患侧每步平均速度为(65.76±8.01)m/min,对照组对应侧为(79.32±6.45)m/min(P<0.05)。结论PID患者运动功能明显下降;IDEEA是动态评估PID患者运动功能的有效工具,具有良好的临床应用价值。

缺铁性贫血对青少年体力能力影响的研究

本文对15例缺铁性贫血和15例正常男生的有氧能力和日常体力活动状况进行研究。根据铁营养状况进行分组,铁营养指标包括血红蛋白、血清铁蛋白、血清铁和血清转铁蛋白受体,研究两组学生的最大耗氧量、相对体重最大耗氧量、相对瘦体重最大耗氧量、最大作功时间、最大心率以及在工作(学习)和休闲时的净心率、能量消耗和有氧活动时间等指标。结果表明,缺铁性贫血学生的最大耗氧量、相对体重最大耗氧量、相对瘦体重最大耗氧量、最大作功时间显著下降;休闲时的净心率和能量消耗较正常对照组明显降低,有氧活动时间显著少于正常对照组。结果提示,缺铁性贫血男性青少年的有氧能力受到损伤,日常体力活动减少。

应用Actigraph三轴加速度传感器矢量计数监测日常体力活动的研究

目的:确定适合我国青年的以Actigraph三轴加速度传感器矢量计数(VM)为自变量的能耗预测方程和判断低、中、高活动强度的VM临界点,为Actigraph三轴加速度传感器的准确应用提供依据。方法:采用Cosmed K4b2便携式气体代谢分析仪和Actigraph GT3X型加速度传感器同步监测受试者体力活动,以间接测热法为能耗监测标准。实验组(男、女各30人)进行静坐、看书、整理书桌、扫地和3种速度的场地上走/跑(4km/h、6km/h和8km/h),以其数据建立VM能耗预测方程和VM临界点,以验证组(男、女各10人)连续约4h的体力活动数据验证本研究所建方程和临界点及文献中已有的VM方程和VM临界点的效度。结果:建立了两个体力活动能耗预测方程(方程1:kcal/min=0.000784×VM+0.054×BM-1.947,方程2:METs=0.000721×VM+1.399),并建立了两组3METs和6METs所对应的VM临界点。经验证,方程1和方程2的PAEE4h预测值与间接测热法测量结果无显著性差异,其他VM方程会显著低估PAEE4h;以ROC曲线法建立的VM临界点可较准确监测4h体力活动内低、中、高强度体力活动的时间,其余VM临界点的监测结果与间接测热法测量结果都有显著性差异。结论:VM是监测日常体力活动的有效变量,建立的VM能耗预测方程和以ROC曲线法建立的VM临界点适用于我国青年日常体力活动监测。

上海市11-16岁青少年体力活动能量消耗参考值研究

目的:建立上海市青少年体力活动能量消耗的参考值。方法:以上海市11-16岁青少年为调查对象,进行体质健康项目测试,并进行体力活动问卷调查。在BMI正常、肺活量和耐力、柔韧力量、速度灵巧项目在及格以上的青少年中,按每2岁一个年龄段分组,每组随机选取男女各200人,用统计学方法分别建立中等强度和大强度体力活动能量消耗的95%置信区间;每年龄组再随机选取男女各20人进行回代检验。结果:11-12岁、13-14岁、15-16岁中等强度体力活动能量消耗(kcal/w)95%置信区间分别为:男生971.19-1271.58、1081.16～1492.94、1324.56-1712.37,女生1139.82-1437.37、1046.69-1398.77、1113.15-1427.22;大强度体力活动能量消耗(kcal/w)95%置信区间分别为:男生1167.75-1486.57、1226.24-1715.26、1117.23-1453.33,女生843.53～1141.61、676.01-1006.54、1142.53-1392.51。回代检验时,各年龄组有75%-87%的对象在所建立的95%置信区间内。结论:初步建立了上海市11-16岁青少年中等强度和大强度体力活动能量消耗的参考值。