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Background/Aims: Paracelsus 10,000 is an observational cohort study with the objective to investigate the health status of the population in and around the city of Salzburg. The focus lies on common non-communicable diseases, mainly cardiovascular, cerebrovascular, and metabolic diseases, and their risk factors. The aim of the study is to establish a large database enabling to study associations between life style, genetic factors and development of common diseases. Extensive phenotyping and biobanking constitute a basis for preventive measures, multi-omics and precision medicine. Methods: Inhabitants of the city of Salzburg and the surrounding areas were randomly selected and underwent a detailed investigation: The program included medical examinations, as well as assessments on mental disorders and life style including nutrition and physical activity. From all study participants biological samples were stored in a biobank at -80°C enabling future investigations of biomarkers and utilization of the whole spectrum of multi-omics. Results: Between the years 2013 and 2020, 10,044 participants, 5,176 women and 4,868 men aged between 40 and 77 years, completed a baseline assessment. Special emphasis was put on participants between 50 and 59 years old, representing an age group especially prone to changes in health status. In this group, 2,606 participants underwent an extended investigation program. Conclusion: The Paracelsus 10,000 study has the potential to gain new insight into the role of associations between genetic predisposition and life style factors for disease development in the Salzburg population. This report describes rationale, objectives and design of the study and provides insight into the main characteristics of the study cohort.

Obesity is a chronic disease, in which treatment outcomes are highly dependent on patient and family adherence to behavioural recommendations. The role of healthy eating, physical activity, medication adherence as well as adherence to pre- and post-bariatric surgery protocols are of utmost importance for long-term treatment outcomes. Even the best interventions are not likely to reach their maximum benefit without significant levels of adherence on the part of the individual and family. Traditionally, the annual meeting of the European Childhood Obesity Group (ECOG) includes an expert workshop addressing one specific topic within the field of childhood obesity. During the 30th annual meeting, hosted by the University of Pécs, Hungary, as a virtual meeting, “adherence to treatment recommendations in obesity as a chronic disease” was addressed. The discussions that developed during the workshop are summarized in the following article.

The aim of this study is to compare data on the health status, self-reported exercise and non-exercise physical activity as well as fitness parameters, such as grip strength, of people in retirement in two cities that are both considered urban centres according to the statistical office of the European Union (EUROSTAT), but differ by geographic location. Self-reported physical activity questionnaires and objective assessments of physical fitness indicators collected by sports scientists were used and examined for differences. A total of 210 people (66.3 years ± 2.3) in Salzburg (n = 90) and Vienna (n = 120) was analysed. While no differences were found in self-reported health, there were differences in self-reported exposure to self-reported exercise and non-exercise physical activity, with the Viennese population being more inactive than their more western comparison group. In addition, the objective indicators for muscle strength, balance and flexibility of the lower extremities differed significantly in favour of the more western Austrian population. We recommend assessing the situation of older people in Austria regarding their physical activity and fitness on a regional basis, even if they live in cities of the same category. Future projects should therefore aim to consider specific regional needs during development and incorporate both subjective and objective indicators when monitoring the success of such programs.

ZusammenfassungRegelmäßige Bewegung trägt sowohl zum Erhalt als auch zur Verbesserung des Gesundheitszustandes bei und ist für die menschliche Entwicklung über die gesamte Lebensspanne des Menschen wichtig. Starke Evidenz hinsichtlich der positiven Auswirkung körperlicher Aktivität auf die Gesundheit liegt in den Bereichen Gesamtsterblichkeit, Krebserkrankungen, Herz-Kreislaufgesundheit, muskuloskelettale Gesundheit, Stoffwechselgesundheit sowie neurokognitive Gesundheit vor. Körperliche Aktivität umfasst jede Form von Bewegung, bei der durch die Kontraktion der Skelettmuskulatur eine Erhöhung des Energieverbrauchs erzielt wird. Sie wird über die Belastungskomponenten Häufigkeit, Dauer, Intensität und Wochenumfang quantifiziert und gesteuert. Als gesundheitswirksame körperliche Aktivität werden all jene Bewegungsformen bezeichnet, welche die Gesundheit verbessern und bei denen das Verletzungsrisiko gering ist. In den Österreichischen Bewegungsempfehlungen werden ausdauerorientierte Bewegung, Krafttraining und Koordinationsübungen empfohlen. Training nimmt innerhalb der gesundheitswirksamen körperlichen Aktivität eine Sonderstellung ein. Es zielt darauf ab, Anpassungsvorgänge im Körper in Gang zu setzen, um Körperfunktionen zu verbessern. Dabei muss die Aktivität an die unterschiedliche individuelle Leistungsfähigkeit, das Aktivitätsniveau und das Alter angepasst und nach bestimmten Grundsätzen durchgeführt werden. Durch das Training kommt es zu einer positiven Veränderung physiologischer Parameter, die wiederum in enger Verbindung mit einer Verbesserung des Gesundheitszustandes steht. Durch regelmäßige ausdauerorientierte und muskelkräftigende Bewegung werden weitreichende Gesundheitseffekte erzielt. Dennoch kann es bei der Ausführung zu unerwünschten Ereignissen kommen. Hiervon betroffen sind v. a. der Bewegungsapparat und das Kreislaufsystem. Durch adäquate Vorbereitung, passende Ausrüstung und richtige Ausübung wird jedoch nicht nur der persönliche, sondern auch der gemeinschaftliche Gesundheitsnutzen durch Bewegung und Sport gesteigert.

ZusammenfassungBasierend auf bereits dargelegten internationalen Empfehlungen werden in diesem Beitrag die Österreichischen Bewegungsempfehlungen für Frauen während der Schwangerschaft und danach, für Kinder im Kindergartenalter sowie für Kinder und Jugendliche in diesem Beitrag vorgestellt. Für Frauen in der Schwangerschaft und in den ersten Monaten nach der Entbindung weichen die Bewegungsempfehlungen nicht von jenen der Erwachsenen ab. Lediglich bei vorliegenden gesundheitlichen Problemen, kann es zu Bewegungseinschränkungen kommen. Kindern unter 6 Jahren sollten so oft wie möglich Bewegungsgelegenheiten geboten werden und sich bis zu 3 Stunden täglich mit mittlerer und hoher Intensität auf vielfältige Weise bewegen können, um ein gesundes Aufwachsen zu ermöglichen. In der Altersgruppe der 6 bis 18-Jährigen wird tägliche Bewegung im Umfang von mindestens einer Stunde empfohlen. Bei der Auswahl der Bewegungsformen sollte der Entwicklungsstand und das Aktivitätsausmaß von Kindern und Jugendlichen beachtet werden, um ein freudvolles überdauerndes Bewegungsverhalten zu garantieren. Die Bewegungsempfehlungen dienen der Verbreitung im Bereich der Gesundheitsförderung und stellen eine Grundlage für die Entwicklung und Evaluation von gesundheitswirksamen Bewegungsprogrammen dar.

The aim of this study was to compare different methods of detecting ventilatory indices (VI) and to investigate the impact of cardiorespiratory fitness (CRF) level on VI detection. Fifty females and fifty males completed a graded exercise test until volitional exhaustion with continuous gas-exchange measurement. The first and second ventilatory indices (VI-1, VI-2) were detected through different single automatic methods and through a semiautomatic method which combines visual and automatic detection methods. Additionally, the VIs were detected visually by two experts which served as the study specific gold standard. When comparing the semiautomatic method at VI-1 (intraclass correlation coefficients (ICC) 0.88 [0.81, 0.92], Bland-Altman bias ± limits of agreement (LoA) 55 ± 334 ml O

Background Paracelsus 10,000 is a prospective cohort study with the objective to investigate the health status of the population in and around the city of Salzburg. The focus lies on common non-communicable diseases, mainly cardiovascular and cerebrovascular diseases, and their risk factors. Methods Inhabitants of the city of Salzburg and the surrounding were randomly selected and underwent a preventive medical checkup. The program included medical examinations, as well as inventories on mental disorders and lifestyle including nutrition and physical activity. From all study participants biological samples were stored in a biobank at -80°C enabling future investigations of biomarkers and utilization of the whole spectrum of multi-omics. Results Between the years 2013 and 2020, 10,062 participants, 5,187 women and 4,875 men aged between 23 and 77 years, were investigated in the study. Participants of the age group 50-59 years, making up 42.3% of the cohort were in the focus of the study. In this group, 2620 participants underwent an extended investigation program. Conclusion The Paracelsus 10,000 study has attained a unique position within the framework of Austrian epidemiological research with the potential to gain new insight into the role of interactions between genetic predisposition and lifestyle factors for disease development in the Salzburg population. This report describes rationale, objectives and design of the study and provides insight into the main characteristics of the study cohort.

Purpose: To compare patterns of sedentary (SED) time (more sedentary, SED+ vs less sedentary, SED-), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs less active, MVPA-) and combinations of behaviors (SED-/MVPA+, SED-/MVPA-, SED+/MVPA+, SED+/MVPA-) regarding nonalcoholic fatty liver diseases (NAFLD) markers. Methods: This cross-sectional study included 134 subjects (13.4±2.2yrs, body mass index (BMI) 98.9±0.7 percentile, 48.5% females) who underwent 24h/7day accelerometry, anthropometric and biochemical markers (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), AST/ALT and Fatty Liver Index (FLI)). A subgroup of 39 patients underwent magnetic resonance imaging-liver fat content (MRI-LFC).Results: Hepatic health was better in SED- [lower ALT, GGT and MRI-LFC (pvs SED+ and in MVPA+ [lower ALT (pvs MVPA- groups after adjustment for age, gender and Tanner stages. SED-/MVPA+ group had the best hepatic health. SED-/MVPA- group had lower ALT and GGT and higher AST/ALT (pConclusions: Lower SED time is associated with better hepatic health independently of MVPA. Reducing SED time might be a first step in the management of pediatric obesity NAFLD when increasing MVPA is not possible.

ZusammenfassungUm dasaktive Alterndurch Bewegung und Sport zu unterstützen, stehen heute zahlreiche Fitness-Apps und Wearables (z. B.: Aktivitätstracker) zur Verfügung. Wissenschaftlich betrachtet ist der Nachweis nicht eindeutig erbracht, ob diese Anwendungen das Bewegungsverhalten verbessern können.Mit dem Projekt Fit-mit-ILSE sind wir dieser Frage bei Personen im Alter von 60 bis 75 Jahren nachgegangen. Es zeigte sich, dass die einer Testgruppe über 14 Wochen zur Verfügung gestellte ILSE-App zu einem signifikanten Bewegungsanstieg gegenüber einer Kontrollgruppe geführt hatte. Der Effekt war mittelstark ausgeprägt, da die App nicht von allen in der TG genutzt wurde. Die tatsächliche Nutzung zu erhöhen bleibt eine Herausforderung für die IKT-basierte Gesundheitsförderung und für die Forschung.

Introduction: While international prevention guidelines recently advocated, in addition to moderate and vigorous physical activity (MVPA) guidelines, for a minimization of sedentary (SED) time, recommendations remain to be developed for youths with obesity. Methods: A literature search was conducted in PubMed, the Cochrane Library, plus the reference lists of selected articles for relevant publications in English, including original papers, systematic reviews, and meta-analyses, with search terms “sedentary behaviors” or “sedentary time” or “screen time” AND “children” or “adolescents” AND “obesity” or “adiposity” or “cardiometabolic risk” or “cardiometabolic disease.” The results were summarized as a narrative review and presented to the scientific board of the European Childhood Obesity Group (ECOG), who then discussed their implication in clinical practice and proposed the position outlined in this paper. Results: SED and screen times are associated with adiposity and cardiometabolic risks, independently of youths’ physical activity (PA) level. Besides considering MVPA and SED times as separate variables, comprehensive studies have questioned the impact of different patterns of MVPA and SED levels. Although lower body adiposity and better cardiometabolic health are achieved among those with desirable movement behavior patterns (i.e., more MVPA/less SED or active/not SED), youths with intermediate patterns (i.e., high MVPA/high SED and low MVPA/low SED, or active/SED and inactive/not SED) have been found to be associated with intermediate risks. Conclusion: There is a need to decrease SED behaviors irrespective of MVPA and to consider PA-SED patterns in youth with obesity. The ECOG encourages anti-obesity strategies targeting both PA and SED behaviors to support the shift from long periods of SED time, especially screen time, to daily routines incorporating bouts of PA. Stepwise or sequential approaches to movement behavior counseling might start with targeting SED at first to decrease cardiometabolic risks when implementing MVPA is not yet possible.

Paracelsus 10,000 is a prospective cohort study with the objective to investigate the health status of the population in and around the city of Salzburg. The focus lies on common non-communicable diseases, mainly cardiovascular and cerebrovascular diseases, and their risk factors in a population-based cohort aged between 40 and 70 years. Between the years 2013 and 2020, 10,062 randomly selected participants (w: 5,187, m: 4,875) were investigated, of whom 2,620 underwent an intensified examination. The program consists not only of medical examinations, but was extended to inventories on mental disorders, lifestyle including nutrition and physical activity. From all study participants biological samples were stored in a biobank at -80°C enabling future investigations of biomarkers and utilization of the whole spectrum of multi-omics. The first follow-up phase of the study has started in late 2020 and will allow us to investigate the development of common non-communicable diseases occurring over time in the cohort of the Paracelsus 10,000 study. This gives the study a unique position within the framework of Austrian epidemiological research with the potential to gain new insight into the role of interaction between genetic predisposition and lifestyle factors for disease development in the Salzburg population. Obtaining high-quality epidemiological data is also of particular relevance for the development of evidence-based prevention strategies. This report describes rationale, objectives and design of the study and provides insight into the main characteristics of the study cohort.

There is evidence that training for strength and balance prevents decline in physical function in old age when the training is personally instructed. It is an open question whether interventions that deliver training via up-to-date technologies can achieve long-term effects. This study examined the effects of an 8-month fitness training program delivered via information and communication technology (ICT) on lower-body strength and balance in female home care users (n = 72) aged 75 years on average. For statistical analysis, the test group was divided into two subgroups, one who used the program at least 8 times per month (n = 26) and another one who used the program less often (n = 17) compared with a control group that received no exercise program (n = 29). It was found that regular ICT-exercisers exhibited positive effects over time on lower-body strength and balance compared to a decrease in both indicators in irregular exercisers and the control group. The authors see potential in offering exercise programs to people of advanced age via ICT to counteract physical decline in old age.

Objective: The aim of this study was to evaluate the feasibility and benefits of an interdisciplinary lifestyle and health program for adolescents embedded in a school setting for maintaining or improving health. Design: Health parameters, anthropometric measurements and 50 biomedical parameters were assessed. A Physical Fitness Test battery was performed and an eencoded and standardized eating and physical activity behaviour questionnaire was used to assess food preferences, behaviour and self-perception. These data were collected at three timepoints. Participants were split into control and intervention group; the latter received a nutrition and health-based workshop. Analysis was focused on changes observed over time within the control and intervention group. Settings: The study was performed as a feasibility study at one federal Austrian school. Participants: Participants included 42 females and 67 males with an average age of 15 years. Results: Overall, the results demonstrated a positive effect on body fat content and physical activity. A trend towards a benefit on parameters of muscle and fat metabolism was detected. Conclusions: An interdisciplinary life-style program integrated into the school curriculum is suited to have a positive impact on health by enhancing the awareness for healthy nutrition and the importance of physical activity

Regular physical activity contributes to both maintaining and improving health, and is important for human development throughout the entire lifespan of a person. There is strong evidence for the beneficial effects of physical activity on health, in the areas of all-cause mortality, cancer, cardiovascular health, musculoskeletal health, metabolic health, and neurocognitive health. Physical activity includes any form of movement in which the contraction of skeletal muscles results in an increase in energy consumption. It is quantified and controlled via the frequency, duration, intensity, and weekly extent. All those forms of movement that improve health and in which the risk of injury is low are defined as health-enhancing physical activity. The Austrian recommendations for health-enhancing physical activity include endurance-oriented movement, plus strength and coordination training. Exercise is aimed at initiating adaptation processes, in order to improve functionality. Therefore, it has to be adapted to the different levels of individual performance ability, activity levels, and age, and should be carried out according to certain principles. Exercise leads to a positive change in physiological parameters, which in turn are closely linked to an improvement in the state of health. Through regular endurance-oriented and muscle-strengthening physical activity, far-reaching health effects can be achieved. Nevertheless, undesirable events can occur during activity, and the musculoskeletal and circulatory systems can be particularly affected. However, through adequate preparation, suitable equipment, and appropriate exercise, the personal and also the public health benefits of physical activity and sport can be increased.Regelmäßige Bewegung trägt sowohl zum Erhalt als auch zur Verbesserung des Gesundheitszustandes bei und ist für die menschliche Entwicklung über die gesamte Lebensspanne des Menschen wichtig. Starke Evidenz hinsichtlich der positiven Auswirkung körperlicher Aktivität auf die Gesundheit liegt in den Bereichen Gesamtsterblichkeit, Krebserkrankungen, Herz-Kreislaufgesundheit, muskuloskelettale Gesundheit, Stoffwechselgesundheit sowie neurokognitive Gesundheit vor. Körperliche Aktivität umfasst jede Form von Bewegung, bei der durch die Kontraktion der Skelettmuskulatur eine Erhöhung des Energieverbrauchs erzielt wird. Sie wird über die Belastungskomponenten Häufigkeit, Dauer, Intensität und Wochenumfang quantifiziert und gesteuert. Als gesundheitswirksame körperliche Aktivität werden all jene Bewegungsformen bezeichnet, welche die Gesundheit verbessern und bei denen das Verletzungsrisiko gering ist. In den Österreichischen Bewegungsempfehlungen werden ausdauerorientierte Bewegung, Krafttraining und Koordinationsübungen empfohlen. Training nimmt innerhalb der gesundheitswirksamen körperlichen Aktivität eine Sonderstellung ein. Es zielt darauf ab, Anpassungsvorgänge im Körper in Gang zu setzen, um Körperfunktionen zu verbessern. Dabei muss die Aktivität an die unterschiedliche individuelle Leistungsfähigkeit, das Aktivitätsniveau und das Alter angepasst und nach bestimmten Grundsätzen durchgeführt werden. Durch das Training kommt es zu einer positiven Veränderung physiologischer Parameter, die wiederum in enger Verbindung mit einer Verbesserung des Gesundheitszustandes steht. Durch regelmäßige ausdauerorientierte und muskelkräftigende Bewegung werden weitreichende Gesundheitseffekte erzielt. Dennoch kann es bei der Ausführung zu unerwünschten Ereignissen kommen. Hiervon betroffen sind v. a. der Bewegungsapparat und das Kreislaufsystem. Durch adäquate Vorbereitung, passende Ausrüstung und richtige Ausübung wird jedoch nicht nur der persönliche, sondern auch der gemeinschaftliche Gesundheitsnutzen durch Bewegung und Sport gesteigert.

Background Obesity numbers have doubled worldwide since 1980, leading to individual life-quality threatening issues and a socioeconomic challenge. A number of school programs have been initiated to prevent the epidemic-like spreading of obesity. Methods 109 adolescents (42 females and 67 males aged 15.0 ± 0.7 years) were included into this six-month interdisciplinary school-based study. The aim was to assess various implementation outcomes based on the effect of health education, including the promotion of healthy eating patterns and a limitation of sugar-containing beverage consumption via the feedback of analysed anthropometric data, biomedical parameters, physical fitness tests and an eating and physical activity behaviour questionnaire. Results Overall, the results demonstrated a positive effect on body fat content and physical activity. In addition, a trend towards a benefit on parameters of muscle and fat metabolism was detected. Conclusions An interdisciplinary life-style program integrated into the school curriculum is suited to have a positive impact on health outcomes. By enhancing the awareness for healthy nutrition and the importance of physical activity, self-empowerment was increased, resulting in an improvement of health-associated parameters.

In this article, based on international recommendations, we present the Austrian physical activity recommendations for women during and after pregnancy, children of kindergarten age, children, and adolescents. For women during pregnancy and in the first months after delivery, the exercise recommendations do not differ from those for adults. Movement restrictions apply only if health problems are present. Children under 6 years of age should engage in a variety of motor tasks for up to 3 hours a day at medium and high intensity levels, so that they can grow up healthy. In the age group of 6 to 18 years of age, daily exercise of at least one-hour duration is recommended. When choosing the type of exercise, the level of development and the activity levels of children and adolescents should be taken into account. The exercise recommendations are intended for dissemination in the field of health promotion and to serve as the basis for the development and evaluation of health-promoting exercise programs in Austria.Basierend auf bereits dargelegten internationalen Empfehlungen werden in diesem Beitrag die Österreichischen Bewegungsempfehlungen für Frauen während der Schwangerschaft und danach, für Kinder im Kindergartenalter sowie für Kinder und Jugendliche in diesem Beitrag vorgestellt. Für Frauen in der Schwangerschaft und in den ersten Monaten nach der Entbindung weichen die Bewegungsempfehlungen nicht von jenen der Erwachsenen ab. Lediglich bei vorliegenden gesundheitlichen Problemen, kann es zu Bewegungseinschränkungen kommen. Kindern unter 6 Jahren sollten so oft wie möglich Bewegungsgelegenheiten geboten werden und sich bis zu 3 Stunden täglich mit mittlerer und hoher Intensität auf vielfältige Weise bewegen können, um ein gesundes Aufwachsen zu ermöglichen. In der Altersgruppe der 6 bis 18-Jährigen wird tägliche Bewegung im Umfang von mindestens einer Stunde empfohlen. Bei der Auswahl der Bewegungsformen sollte der Entwicklungsstand und das Aktivitätsausmaß von Kindern und Jugendlichen beachtet werden, um ein freudvolles überdauerndes Bewegungsverhalten zu garantieren. Die Bewegungsempfehlungen dienen der Verbreitung im Bereich der Gesundheitsförderung und stellen eine Grundlage für die Entwicklung und Evaluation von gesundheitswirksamen Bewegungsprogrammen dar.

ZusammenfassungDas Ziel des BARI-AD ist die strukturierte Erfassung der für eine Adipositas-chirurgische Operation und den postoperativen Erfolg Jugendlicher als relevant erachteten Voraussetzungen. Es dient als Grundlage für eine präoperative schriftliche Stellungnahme an die Chirurg/innen und Sozialversicherungen sowie vor- und nachsorgender interdisziplinärer Maßnahmen. BARI-AD erhebt strukturiert Vorstellungen, Wissen, Verständnis, Handlungsmöglichkeiten der PatientInnen bezüglich der intra- und interdisziplinären prä- und postoperativen Notwendigkeiten, Stärken und Beeinträchtigungen. Zur objektiven und systematischen Extraktion der Inhalte der Leitlinien nationaler und internationaler Fachgesellschaften wurden qualitative Inhaltsanalysen durchgeführt und die Inhalte in ein strukturiertes Interview gefasst. Procedere und Gesprächsführung basieren auf aktuellen psychologischen Erkenntnissen. Das strukturierte Interviewschema erhebt und dokumentiert die in Leitlinien geforderten Informationen zur psychischen und sozialen Situation der Patient/innen nach der Aufklärung durch das interdisziplinäre Team vor bariatrischen Eingriffen.

Objectives Regular aerobic exercise provides beneficial effects on human health and reduces all-cause mortality. Aerobic exercise has profound metabolic effects, and specific metabolites may reflect physiological changes. We aimed to identify endogenous metabolites that distinguish the trained from the untrained state to increase the spectrum of analytes amenable for hypothesis testing and to expand understanding of putative beneficial pathways. Design Cross sectional laboratory repeated measures study. Methods Exercise testing was performed in 37 healthy male participants and serum samples were obtained before and after completion of a ten-week standardized exercise program. Samples were analyzed for routine clinical parameters and for 188 endogenous metabolites by LC–MS/MS. Results Indicating the effectiveness of the intervention program, parameters of sport physiology were different after training. After correcting for multiple testing, serum concentrations of several metabolites differed between the trained and untrained state. Serine and glutamate decreased in response to exercise, whereas sarcosine and kynurenine increased. Phosphatidylcholines showed a mixed response in that four species increased and three decreased. However, all seven lysophosphatidylcholines and all four plasmalogens that differed between the trained and untrained state, increased. One short-chain acylcarnitine also decreased. In receiver operator characteristics analyses, sarcosine displayed the highest AUC value (0.839; 95% CI: 0.734–0.926) in discriminating the pre- from the post-trained state. Conclusions Our study detected metabolites that clearly differentiate the trained from the untrained state. These metabolites may be targeted in mechanistic studies to understand underlying biochemical pathways and could serve to improve the design, monitoring and individualization of training programs.

Objective To validate a semi-automated method for thigh muscle and adipose tissue cross-sectional area (CSA) segmentation from MRI. Materials and methods An active shape model (ASM) was trained using 113 MRI CSAs from the Osteoarthritis Initiative (OAI) and combined with an active contour model and thresholding-based post-processing steps. This method was applied to 20 other MRIs from the OAI and to baseline and follow-up MRIs from a 12-week lower-limb strengthening or endurance training intervention (n = 35 females). The agreement of semi-automated vs. previous manual segmentation was assessed using the Dice similarity coefficient and Bland-Altman analyses. Longitudinal changes observed in the training intervention were compared between semi-automated and manual segmentations. Results High agreement was observed between manual and semi-automated segmentations for subcutaneous fat, quadriceps and hamstring CSAs. With strength training, both the semi-automated and manual segmentation method detected a significant reduction in adipose tissue CSA and a significant gain in quadriceps, hamstring and adductor CSAs. With endurance training, a significant reduction in adipose tissue CSAs was observed with both methods. Conclusion The semi-automated approach showed high agreement with manual segmentation of thigh muscle and adipose tissue CSAs and showed longitudinal training effects similar to that observed using manual segmentation. Electronic supplementary material The online version of this article (doi:10.1007/s10334-017-0622-3) contains supplementary material, which is available to authorized users.

Childhood Obesity : The Need to Translate Research into Daily Practice: Announcing the Annals of Nutrition and Metabolism as the Official Journal of the European Childhood Obesity Group

The prevalence of pediatric obesity continues to increase worldwide, bringing with it various metabolic, functional, social, and psychological complications.1 Both the prevention and treatment of childhood obesity must be based on multidisciplinary approaches combining nutrition, physical activity (PA), and psychological support.2 As an essential element of these multicomponent strategies, regular physical activity has been acknowledged as having beneficial effects on children's and adolescents’ body composition, physical fitness, and metabolic profile, as well as on their health-related quality of life, social and psychological health, and academic achievement.3, 4 Given that only a relatively small proportion of children and adolescents meet the public health recommendations for PA,5 and given that weight loss exercise-based interventions suffer from a high attrition rate, there is a clear need for appropriate PAs. Traditional sports, including football, handball, gymnastics, athletics, and martial arts, are usually defined as specific and structured activities organized through rules and specific regulations under the control and administration of sports associations and federations. As a part of the overall PA compendium, could these and other classical sporting activities provide a relevant alternative for the prevention and treatment of pediatric obesity? An entire session was dedicated to this question at the 28th European Childhood Obesity Group Congress (ECOG) held in Porto, Portugal, on 13–16 November 2018; the session brought together international experts in the field. This article summarizes the initial conclusions of this expert panel and details the main considerations when it comes to recommending traditional sports for the prevention and/or treatment of pediatric overweight and obesity.

Stellt man sich ein Kontinuum der auseren Gestalt des Korpers von dicken zu dunnen Menschen vor, so ist diese eindimensionale Vorstellung nur rein metrisch zutreffend. Eher passt das Bild von Korpern, das von unterschiedlichen Betrachtern geschaffen wird, zu einer Landschaft bestehend aus verschiedenen Formationen, die komplexen Entstehungs- und Veranderungsmechanismen in der Postmoderne unterliegen und oft tief eingegrabene Leidenswege aufweisen. Zudem uberlagern sich die Bilder, da ein Teil der Menschen mit einem wesentlich uberhohten Fettanteil auch Vollbilder von Essstorungen aufweisen.

The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding potential musculoskeletal impairments. The purpose of the present systematic review was to report the evidence regarding muscular fitness in children and adolescents with obesity. A systematic article search was conducted between November 2014 and June 2015 using MEDLINE, EMBASE, CINAHL psycINFO, SPORTDiscus and SocINDEX. Articles published in English and reporting results on muscle strength and muscular fitness in children and adolescents aged 6 to 18 years were eligible. Of 548 identified titles, 36 studies were included for analyses. While laboratory-based studies described higher absolute muscular fitness in youth with obesity compared with their lean peers, these differences are negated when corrected for body weight and lean mass, then supporting field-based investigations. All interventional studies reviewed led to improved muscular fitness in youth with obesity. Children and adolescents with obesity display impaired muscular fitness compared to healthy-weight peers, which seems mainly due to factors such as excessive body weight and increased inertia of the body. Our analysis also points out the lack of information regarding the role of age, maturation or sex in the current literature and reveals that routinely used field tests analysing overall daily muscular fitness in children with obesity provide satisfactory results when compared to laboratory-based data.

Background The point of optimal ventilatory efficiency (POE) and the anaerobic threshold (AT) are traditionally considered the same ventilatory indices, but recently differences between them have been reported. Therefore, the aim of this study was to identify different response patterns regarding POE and AT, and to analyse differences in breathing patterns as a possible explanation. Methods 118 females and 199 males aged 50 to 60 years performed an exercise test with gas analysis. POE and AT were determined, and the breathing patterns concerning ventilation, breathing frequency and tidal volume were assessed. Results and Conclusion Our study identified two different response patterns concerning the ventilatory indices POE and AT. Participants with a work rate difference between POE and AT (82% of all participants) were not different regarding breathing patterns of breathing frequency and tidal volume. However, the difference in work rate was explained by an early increase in ventilation and a higher aerobic capacity.

Sarkopenie, ubersetzt die Fleischarmut (griech. sarka = Fleisch, penia = Mangel, Armut), meint den altersbedingten und normalen Verlust an Skelettmuskelmasse, sofern keine Erkrankung oder eine strenge Diat als Ursachen vorliegen. Bei einem uber der Alters- und Geschlechtsnorm liegenden Verlust der Muskelmasse kommt es jedoch zu einem deutlichen Verlust der Funktionskapazitat des Herzkreislauf- und Stoffwechselsystems, was sich im Alltag in einer Abnahme der Kraftfahigkeit und Reduzierung der Gehgeschwindigkeit ausern kann.

Background: The prevalence of early childhood overweight and obesity in Austria has reached average European levels of 20% in boys and 18% in girls. The rationale and study protocol of SALTO, Salzburg Together against Obesity will be presented, which is aimed to assist adults in increasing the rate of 4- to 6-year-old children with a healthy body weight. Methods: A controlled longitudinal sequential study design consisting of 14 intervention (IK) and 8 control (CK) kindergarten was used to investigate the effect of actions tailored for teachers and parents on BMI among 4- to 6-year-old children. The study launched in November 2014 was approved by the ethics committee of the University of Salzburg. Results: 681 children, 181 parents (119 mothers, 62 fathers) and 30 teachers were investigated until October 2016. Preliminary analyses revealed that more boys (19%) and fathers (60% IK, 43% CK) were overweight and obese than girls (16%) and mothers (19% IK, 20% CK). Conclusion: The challenges faced by the SALTO staff in the implementation of health-promoting actions in the kindergarten are manifold. The Community-Oriented Core Setting (COCS) intervention approach will show whether the actions will reduce the percentage of obesity and be sustainable in the long term.

One of the main aims of the European Childhood Obesity Group (ECOG) is to assist healthcare workers in delivering evidence-based assessment and treatment of childhood obesity. Every year the ECOG Congress includes working groups whose objective is to highlight concerns faced by clinicians and practitioners who work in the field of pediatric obesity. This year, a working group was devoted to the assessment of physical activity and physical fitness in this population. The present commentary attempts to summarize the main themes identified by practitioners during these workshops in order to provide the basic and essential first steps required to address physical activity and fitness in children with obesity.

Quadriceps heads are important in biomechanical stabilization and in the pathogenesis osteoarthritis of the knee. This is the first study to explore the relative distribution of quadriceps head anatomical cross-sectional areas (ACSA) and volumes, and their response to pain and to training intervention.The relative proportions of quadriceps heads were determined in 48 Osteoarthritis Initiative participants with unilateral pain (65% women; age 45-78 years). Quadriceps head volumes were also measured in 35 untrained women (45-55 years) before and after 12-week training intervention. Cross-sectional areas of the vastus medialis (VM), inter-medius (VIM), and lateralis (VL), and of the rectus femoris (RF) were determined from axial T1-weighted MR images.The proportion of the VM on the total quadriceps ACSA increased from proximal to distal. The difference in quadriceps ACSA of painful (vs. pain-free) limbs was -5.4% for the VM (p0.001), -6.8% for the VL (p0.01), -2.8% for the VIM (p=0.06), and +3.4% for the RF (p=0.67) but the VM/VL ratio was not significantly altered. The muscle volume increase during training intervention was +4.2% (p0.05) for VM, +1.3% for VL, +2.0% for VIM (p0.05) and +1.6% for RF.The proportion of quadriceps head relative to total muscle ACSA and volume depends on the anatomical level studied. The results suggest that there may be a differential response of the quadriceps heads to pain-induced atrophy and to training-related hypertrophy. Studies in larger samples are needed to ascertain whether the observed differences in response to pain and training are statistically and clinically significant.

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport-specific exposure, 240 players reported 492 injuries, representing an overall injury rate of 12.2 injuries/1000 h of exposure. Most injuries were classified as bagatelle injuries (67.8%). The majority of the injuries were located in the knee (23.5%) followed by the elbow (11.9%) and the hip (11.5%). Ankle injuries resulted in the longest impairment from sports participation. The most common types of injury were abrasions (38.2%), contusions (21.1%), distortions (7.5%) and muscle strains (6.9%). Wrong or insufficient equipment (15.0%) was the most commonly mentioned causes of injury. The data indicate that the injury risk in fistball is rather high; however, the sport should not be considered a high-risk sport because most of the injuries are slight and do not prevent the players from training or competition. Injury prevention strategies should include the development of fistball-specific protective equipment with focus on the knee and elbow joint.

Background: Interdisciplinary state-of-the-art interventions to treat obesity demand equally interdisciplinary outcome assessments. The Bariatric Evaluation Score for Children (BAREV-C) was developed to reliably and comprehensively assess the outcomes of non-surgical and surgical obesity treatment in children and adolescents. Methods: BAREV-C assesses medical, psychological, nutritional, and data of physical fitness data. The body mass index standard deviation score and waist measurement were selected to describe anthropometry. Serum triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and plasma glucose tolerance were selected as parameters of the metabolic syndrome. Relevant interdisciplinary variables were tested using the interdisciplinary Adiposity Evaluation kit, which assesses cognitive steering variables of eating and exercise behaviour as well as psychological comorbidities, exercise motivation, nutritional preferences, and quality of life associated with obesity. Physical fitness was assessed by means of the Physical fitness test battery. The values for the BAREV-C were determined in several steps and in all relevant disciplines pre and post intervention. Results: The BAREV-C facilitated the identification and quantification of significant changes of interdisciplinary variables associated with obesity for groups and individuals (tables of critical differences) as well. The degree of success or failure of an intervention can be quantified for each of the disciplines. Conclusions: The BAREV-C is the first comprehensive outcome instrument for pre-post-intervention evaluation of obese individual children as well as groups. It can be applied for intervention studies and can provide the clinician with a differentiated overview in daily practice.

Chirurgische Adipositastherapie erzielt die fur die Vermeidung, Besserung oder Heilung von lebensgefahrlichen Komorbiditaten notige dauerhafte Gewichtsabnahme. Uber Veranderungen der psychologischen Atiologie- und Risikofaktoren weis man aber bislang wenig. In der vorliegende Studie wurde die Veranderung von auch subjektiv stark belastenden Atiologiefaktoren von Adipositas an 60 PatientInnen vor (24 m/36 w, 18–71, Body-Mass-Index [BMI] M=44,95, SD=6,91) und nach (BMI M=33,92, SD=7,23) einer Bypass- bzw. Magenbandoperation mithilfe des neuen Testsystems AD-EVA uberpruft. Die Variablen „Sucht“ (t=11,15, p

The purpose of this study was to determine whether physical activity, with and without lower body pressure, leads to increased regional fat loss in the lower extremities of overweight females. Eighty-six obese women with a female phenotype were randomly assigned into four groups: control group (C), diet only (D), diet plus exercise (DE) or diet, exercise and lower body pressure intervention (DEP). The three treatment groups followed the same diet, the two exercise groups (DE and DEP) additionally followed an endurance training program of 30 min of cycling at 50%VO2max three times per week with or without lower body pressure. Body composition and fat distribution were assessed by DXA. Body size circumference measurements were recorded as well as subjective ratings of cellulite and skin appearance. As expected, all test groups (D, DE, DEP) showed a significant decrease (p

The objective of this study was to evaluate the location-specific magnitudes of an exercise intervention on thigh muscle volume and anatomical cross-sectional area, using MRI. Forty one untrained women participated in strength, endurance, or autogenic training for 12 weeks. Axial MR images of the thigh were acquired before and after the intervention, using a T1-weighted turbo-spin-echo sequence (10 mm sections, 0.78 mm in-plane resolution). The extensor, flexor, adductor, and sartorius muscles were segmented between the femoral neck and the rectus femoris tendon. Muscle volumes were determined, and anatomical cross-sectional areas were derived from 3D reconstructions at 10% (proximal-to-distal) intervals. With strength training, the volume of the extensors (+3.1%), flexors (+3.5%), and adductors (+3.9%) increased significantly (P < 0.05) between baseline and follow-up, and with endurance training, the volume of the extensor (+3.7%) and sartorius (+5.1%) increased significantly (P < 0.05). No relevant or statistically significant change was observed with autogenic training. The greatest standardized response means were observed for the anatomical cross-sectional area in the proximal aspect (10-30%) of the thigh and generally exceeded those for muscle volumes. The study shows that MRI can be used to monitor location-specific effects of exercise intervention on muscle cross-sectional areas, with the proximal aspect of the thigh muscles being most responsive.