Obesity Clinical Trial
Official title:
Changes in Body Composition, Metabolic and Mechanical Responses to Hypoxic Walking Training in Obese Patients
By analyzing energetic and biomechanical basis of walking, and the subsequent changes
induced by hypoxic vs normoxic training in obese individuals, it may optimize the use of
walking in hypoxia to gain perspective for exercise prescription to set up training programs
that aim to induce negative energy balance and to deal with weight management. However to
the investigators knowledge, the analysis of changes in mechanics, energetics and efficiency
of walking after continuous hypoxic training (CHT) has not been performed yet.
The aims of the present study were:
1. Comparing the changes in body composition between continuous hypoxic training (CHT) and
similar training in normoxia; e.g. continuous normoxic training (CNT) in obese
subjects.
2. Comparing the metabolic and energetics adaptations to CHT vs CNT.
3. Finally, comparing the associated body‐loss induced gait modification since walking
intensity at spontaneous walking speed (Ss) is lower in CHT than in CNT.
Hypoxic training embraces different methods as "live high - train high" (LHTH) and "live
high - train low" (LHTL); sleeping at altitude to gain the hematologic adaptations
(increased erythrocyte volume) but training at sea level to maximize performance
(maintenance of sea level training intensity and oxygen flux). The LHTL method can be
accomplished via a number of methods and devices: natural/terrestrial altitude, nitrogen
dilution, oxygen filtration and supplemental oxygen. Another method is the "live low - train
high" (LLTH) method including intermittent hypoxic exposure at rest (IHE) or during
intermittent hypoxic training sessions (IHT). Noteworthy, all supporting references were
conducted with endurance elite athletes (i.e. cyclists, triathletes, cross-country skiers,
runners, swimmers, kayakers, rowers) and there is an extensive literature relative both on
LHTH and LHTL (Millet et al. 2010). Interestingly, very recently, the investigators research
group proposed a new LLTH method (e.g. repeated sprints training in hypoxia; RSH) for
team-sports players (Faiss et al. 2013). This lead to modify the nomenclature (Millet et al.
2013) and to divide LLTH method in four subsets; i.e. IHE, CHT (continuous >30 min low
intensity training in hypoxia), IHT (interval-training in hypoxia) and RSH, based
predominantly on different mechanisms; e.g. increased oxidative capacity (CHT), buffering
capacity (IHT) or compensatory fiber-selective vasodilation (RSH). These new nomenclature
and hypoxic methods open doors for investigating the use of different LLTH methods with
other groups and for other purposes than the oxygen transport enhancement.
Several recent findings support the use of LLTH in obese subjects in terms of weight loss
and/or cardiovascular and metabolic improvements (Kayser and Verges 2013). CHT [low
intensity endurance exercise for 90 min at 60% of the heart rate at maximum aerobic
capacity, 3 d week-1 for 8 weeks; fraction of inspired oxygen (FiO2) = 15%] in overweight
subjects [body mass index (BMI) > 27] lead to larger (+1.1 kg) weight loss than similar
training in normoxia. However, no difference was observed regarding BMI between the training
modalities (Netzer et al. 2008). In a similar way, CHT (low intensity endurance exercise for
60 min at 65% of the heart rate at maximum aerobic capacity, 3 d week-1 for 4 weeks; FiO2 =
15%) induced similar increases in maximal oxygen consumption and endurance but larger
improvements in respiratory quotient and lactate at the anaerobic threshold as well as in
body composition than similar training in normoxia (Wiesner et al. 2010). Of interest is
that the beneficial results were obtained despite lower training workload in hypoxia. This
suggests that hypoxic training intensity can be lower in absolute value, at the spontaneous
walking speed (Ss), also known as preferred or self-selected speed (e.g. the speed normally
used during daily living activities). This appears to be an appropriate walking intensity
for weight reduction programs aimed at inducing negative energy balance (Hills et al. 2006).
A lower walking intensity is also likely more protective of the muscles/joints in obese
patients with orthopaedic comorbidities. Finally, CHT was also shown (Haufe et al. 2008) to
lead to larger change in body fat content, triglycerides, homeostasis assessment of insulin
resistance (HOMA-Index), fasting insulin and area under the curve for insulin during an oral
glucose tolerance test despite the lower absolute running intensity (1.4 and 1.7 W kg-1 in
hypoxia and normoxia, respectively).
The net energy cost of level walking (NCw) represents the energy expenditure per distance
unit only associated with walking movements. Previous studies reported higher absolute
(J·m-1) and relative (i.e., normalized by body mass: J·kg-1·m-1) NCw in obese compared with
normal body mass individuals (Browning et al. 2006; Peyrot et al. 2009), suggesting that the
body mass is the main, but not the only, determinant of this lower economy of walking in
obese subjects and that other factors may be involved in the higher NCw in these
individuals(Browning et al. 2006; Peyrot et al. 2010; Peyrot et al. 2009). If body mass loss
is an important method for the treatment of obesity and its associated co-morbidities and it
may also be an important to investigate the effect of decreased body mass on gait pattern
and mechanical external work (Wext) and their consequences on NCw in obese individuals.
Walking is a fundamental movement pattern and the most common mode of physical activity.
This form of locomotion may contribute significantly to weight management in overweight and
obese subjects (Hill and Peters 1998; Jakicic et al. 2003; Pollock et al. 1971). Only one
study showed that body mass reduction of 7% over 3 months resulted in gait kinematic changes
(i.e., increases in walking speed, stride length and frequency, swing duration and decrease
in cycle time, stance and double support time) in healthy adult obese women (BMI = 37
kg·m-2) (Plewa et al. 2007). However, these authors did not measure the NCw. More recently,
Peyrot et al. (Peyrot et al. 2010) reported that, in healthy adolescent obese individuals, a
12-wk voluntary body mass reduction program (-6%) induced a reduction in NCw mainly
associated with decreased body mass but also with changes in the biomechanical parameters of
walking [i.e., a lesser lower limb muscle work required to rise the center of mass (CM) with
Wext unchanged after intervention]. The authors hypothesized that the relation between the
changes in absolute NCw and the changes in the biomechanical parameters might be explained
by an increase in efficiency of muscle mechanical work with body mass loss as previously
showed in cycling (Rosenbaum et al. 2003). Others studies (Messier et al. 2005; Messier et
al. 2011), investigating only the effect of body mass loss (-3% and -10%, respectively) on
biomechanical parameters of walking in non-healthy overweight and obese older adults with
knee osteoarthritis, demonstrated that this body mass loss increased walking speed and
reduced knee joint forces. Bariatric surgery may induce greater body mass loss (~30-40%)
(Chaston et al. 2007) compared with exercise, diet or pharmaceutical interventions (~10%)
(Franz et al. 2007) and may be considered as an interesting tool to maximize the effect of
body mass loss on Wext and NCw in obese individuals and, thus, investigate the relationship
between the gait pattern changes and the extra cost of walking in these subjects. Similarly,
it would be of interest to investigate how the metabolic changes and body mass loss induced
by CHT, potentially associated with an increased metabolic efficiency, would affect gait
pattern and the extra cost of walking in obese subjects.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment
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