A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia - appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

Background: Evidence of the benefits induced from resistance exercise on health markers of post-bariatric patients is limited. The study will investigate the effects of a resistance training (RT) program on muscle mass and strength, bone metabolism biomarkers, bone mineral density (BMD), bone microarchitecture, and endothelial function of patients subjected to Roux-en-Y gastric bypass. Methods/design: This randomized controlled trial will include 60 post-bariatric patients, physically inactive, aging 18 to 50 years, with a post-surgery period ≥ 12 months. They will be randomly assigned into two groups: (i) the non-exercised control group, which will receive the standard clinical follow-up, or (ii) the intervention group which will consist of RT (60 min/session; 3 times/week, for 6 months). The primary outcomes will include muscle mass and strength, bone metabolism biomarkers, BMD, and bone microarchitecture. The secondary outcomes will be anthropometry, hemodynamic measurements, cardiovascular risk factors, health-related quality of life (QoL), and endothelial function. Outcomes will be assessed by blood biomarkers of bone formation and reabsorption, dual X-ray absorptiometry, repetition maximum and handgrip strength tests, high-resolution peripheral quantitative computed tomography, 36-Item Short-Form Health Survey, venous occlusion plethysmography, and nailfold videocapillaroscopy. Discussion: It is expected that there are greater benefits from the RT program, possibly improving muscle mass and strength, bone metabolism, density and microarchitecture, QoL, and cardiovascular risk. Trial registration: ClinicalTrials.gov NCT04193397. Registered on 7 December 2019.

Background: Evidence on the effects of exercise training on the bone health of men and women living with HIV (MLHIV and WLHIV) is limited.Objective: To investigate the effects of a long-term multimodal exercise program on the bone mineral density (BMD) of MLHIV and WLHIV.Methods: A retrospective cohort of 39 patients (13 women; 48.4 ± 7.6 y; HIV-infection for 15.5 ± 6.5 y; combined antiretroviral therapy for 12.2 ± 7.0 y) performed a multimodal exercise program (60-min sessions of aerobic, resistance, and flexibility exercises performed 3 times/week for 9-106 months). MLHIV and WLHIV were allocated into groups showing either advanced osteopenia/osteoporosis or normal BMD (+ or -).Results: MLHIV+ increased BMD at the femoral neck, total femur, and lumbar spine (∼3-4%) compared to MLHIV- (p ≤ 0.03). Changes in whole-body BMD were similar between MLHIV groups (p = 0.55). WLHIV+ exhibited higher loss of BMD at the femoral neck (∼6%) than WLHIV- (p = 0.04), whereas reductions in the whole-body, total femur, and lumbar spine (∼3-5%) were similar between groups (p ≥ 0.25). Among men, changes in femoral neck BMD were inversely correlated to femoral neck T-score (r = -0.62; p < 0.001), but not to the time of follow-up, appendicular skeletal muscle mass (ASM) index, or age (p ≥ 0.08). In women, these changes were inversely correlated with time of follow-up (r = -0.58) and age (r = -0.70) and positively correlated with femoral neck T-score (r = 0.46) and ASM index (r = 0.47) (p < 0.01).Conclusion: Multimodal exercise training may improve the BMD in people living with HIV, especially men with advanced osteopenia/osteoporosis. Adjuvant therapies to exercise should be considered to counteract losses in WLHIV.

Background/objective: Weight regain has serious health consequences after bariatric surgery, and disordered eating behaviors (EBs) may be involved in it. We compared disordered EB symptoms in post-bariatric patients according to low vs. high ratio of weight regain (RWR) and investigated associations between disordered EB symptoms with weight regain and time since surgery. Method: We recruited ninety-four patients who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. All of them had not attended follow-up with the multidisciplinary healthcare team (including psychological assessment) for at least one year. RWR was calculated with respect to maximal weight loss by the nadir weight achieved after surgery. Patients were divided into two groups: high RWR (≥20%) or low RWR (<20%). At their first visit, we had them complete the Eating Disorder Examination and Repetitive Eating Questionnaires (EDE-Q and Rep(eat)-Q). Results: Patients with high RWR reported higher EDE-Q global, dietary restraint and weight concerns without significant group differences in eating and shape concerns. Compared to those patients with low RWR, these patients also indicated greater Rep(eat)-Q global, compulsive grazing and repetitive eating. Global EDE-Q score, eating concern, shape concern, weight concern and all Rep(eat)-Q indexes were positively associated with higher RWR. Conclusions: Disordered EBs occurred more frequently in the group with high RWR. In these patients, eating behavior symptoms and grazing behavior were both correlated to the RWR, suggesting a possible involvement of both conditions in weight regain.

Combination antiretroviral therapy (cART) substantially extended the life of people living with HIV (PLHIV). However, prolonged HIV infection and cART increase the risk of comorbidities accelerating age-related muscle, bone, and vascular disorders. This cross-sectional study compared muscle mass and strength, bone mineral density (BMD), and vascular function in middle-aged PLHIV treated with cART vs. non-infected age-matched and older controls. After careful screening for secondary diseases and medications, body composition, muscular and vascular function were assessed in 12 PLHIV (43.9±8.7 yrs old; HIV-infection for 16.2±8.6 yrs; on cART for 11.6±9.2 yrs), 12 age-matched (CONT, 43.2±8.5 yrs old), and 12 older (OLDER, 74.4±8.3 yrs old) controls through dual x-ray absorptiometry, isokinetic dynamometry, and venous occlusion plethysmography, respectively. PLHIV and CONT showed similar relative muscle mass (65.3±8.0 vs. 66.9±7.3%, respectively; P= 0.88) and strength (160.7±53.9 vs. 152.0±52.9 N.m⁻¹, respectively; P= 0.90), which were greater than OLDER (80.6±18.8 N.m^−1; P= 0.001). Total BMD was similar in PLHIV (1.04±0.13 g.cm⁻²) and OLDER (1.00±0.15 g.cm⁻², P= 0.86), and both groups presented lower values than CONT (1.20±0.13 g.cm⁻², P< 0.01). No significant difference across groups was detected for macrovascular reactivity (P= 0.32). Age-related osteopenia might be accelerated in middle-aged PLHIV on prolonged cART, as their BMD approached values found in older adults. On the other hand, muscle mass, isokinetic strength, and vasodilation capacity were similar in PLHIV and age-matched uninfected controls.