Title: Climbing in children and youth: acute physiological responses to climbing and their implications for upper body strength. Objectives: The aim of this thesis was to determine the physiological responses of children and youth to climbing and its implications for upper body strength. Methods: One hundred and twelve children (aged 9,8 ± 1,4 years) participated across two studies. Study one (91 children) explored the effects of climbing on upper body strength, with the aid of a battery of climbing specific tests (bent arm hang on the trapeze, finger hang on the wooden bar and maximal hand grip with the manual dynamometer). These tests were designed for the measurement of the key muscle groups involved in climbing. Study two (21 children) assessed acute physiological response to climbing using the indirect calorimetry method. Energy expenditure was used as an indicator of the climbing skills and to express the total climbing work completed. Study two lasted for 16 weeks, during this time the children underwent three measurements. Instructors recorded the routes climbed and their difficulty during each session. The period of the study corresponded with the duration of the climbing course for children during the school year. The results of the acute physiological response of children during climbing...

Huntington's disease is a dominantly-inherited autosomal neurodegenerative disease manifested by disorders of motility, cognitive function, behaviour, and weight loss, which is conditioned multifactorially. The aim of the study was to determine whether there are eating disorders in Huntington's disease, as well as its etiology and severity. Neurological scaling, anthropometric examinations, evaluation of three-day diet records, measurements with a manual dynamometer, bioimpedance analyses, indirect colorimetry and predictions of energy expenditure were performed on 10 patients. Algorithms were applied for the diagnosis of sarcopenia and malnutrition. Unwanted weight loss was observed in all patients and 4 out of 10 showed malnutrition. No difference was found between the values of measured resting metabolism and calculated according to the predictive equation. However, it has been shown that strict nutritional recommendations based on this data can be misleading for some patients with HN, as real energy consumption can be significantly higher. All our patients had a positive energy balance. A new diagnostic algorithm for the early diagnosis of sarcopenia has proven its worth. Using bioimpedance analysis and examination of the force of the handshake, we identified possible sarcopenia and already-present...

Aims: The aim of this work was to determine whether a increased resting energy expenditure contributes to the nutritional risk for patients with pancreatic cancer. What the variability of resting energy expenditure is and whether it predicts weight loss. Another aim was to verify that lower protein-energy intake also has an impact on weight loss. Methods: Data for the diploma thesis were obtained from the project "Pancreatic Cancer: Metabolic Derangements Associated With Insulin Resistance", which takes place at the Department of Clinical Physiology of Metabolism at 2nd Department of internal medicine in the University Hospital Královské Vinohrady. The project includes 40 - 50 patients with pancreatic tumor resection per year. Data were collected from the beginning of December 2019 until the end of April 2020. The project is funded by the grant AZV NV19-01-00101. 10 consecutive patients (4 women and 6 men) with pancreatic cancer who had a complete dataset for analysis were selected for the research set for the diploma thesis. The patients underwent anthropometric examination, blood tests were taken, and indirect calorimetry was performed. Results: The first part of the research was focused on anthropometric parameters, parameters of nutritional status and the presence of cancer cachexia. The second...

Zur Ermittlung des Energieverbrauches bei Mensch und Tier stehen verschiedene Methoden zur Verfügung. Im Jahre 1780 nutzte Lavoisier die Schmelzwassermenge, um den Energieverlust eines Meerschweinchens zu berechnen. Das Tier saß in einem von Eis umgebenen Kalorimeter, die von ihm abgegebene Wärme brachte das Eis zum Schmelzen. Derzeit sind die indirekte Kalorimetrie, die den Energieumsatz über den im Respirationsversuch gemessenen Gaswechsel von O2 und CO2 sowie die im Harn ausgeschiedene Stickstoffmenge bestimmt, und die Isotopendilutionsmethode, die mit der unterschiedlichen Ausscheidungsrate von markierten Wasserstoff- (2H) und Sauerstoff- (18O) Atomen im Urin arbeitet, der „Goldstandard“ für die Bestimmung des Energieverbrauchs. Seit einigen Jahren bis heute steht die Herzfrequenzmethode in der Diskussion. Sie nutzt die Beziehung zwischen Herzfrequenz und Sauerstoffverbrauch zur Ermittlung des Energieumsatzes. Alle genannten Methoden haben Vor- und Nachteile, insbesondere für den einfachen und schnellen täglichen Einsatz sowie bei Langzeitstudien. Deshalb werden Alternativen gesucht. Diese Dissertation untersucht die Beziehung zwischen der akzelerometrisch erfassten dreidimensionalen Körperbeschleunigung und der Herzfrequenz beim Pferd in verschiedenen Gangarten. Dabei wird die Herzfrequenz als Vergleichs- und Bezugsgröße verwendet. Sie stellt das direkte Bindeglied zum Sauerstoffverbrauch und damit Energieaufwand dar. Es wurden drei Versuchsvarianten durchgeführt. Die Pferde gingen an der Hand, „geführt“, liefen frei in einem umzäunten Oval, „freilaufend“, oder wurden „geritten“. Bei den beiden Varianten „geführt“ und „freilaufend“ kamen jeweils dieselben vier Pferde zum Einsatz, die Variante „geritten“ absolvierten fünf andere Tiere. Die Versuche folgten verschiedenen Schemata mit den Gangarten Schritt, Trab und, zum Teil, Galopp. Bei allen Versuchen wurden parallel die dreidimensionale Körperbeschleunigung mit einer Frequenz von 32 Hz sowie die Herzfrequenz gemessen. Die Pulsuhr speicherte im kleinstmöglichen Intervall von fünf Sekunden. Nach Aufbereitung der Beschleunigungsrohdaten wurde letztendlich der dynamische Anteil der dreidimensionalen Beschleunigung in Form von „fünf-Sekunden-Mittelwerten“ berechnet. Anschließend wurden diese Beschleunigungswerte über die Regressionsanalyse mit den Originalwerten der Herzfrequenz in Beziehung gesetzt. Dabei wurden die Übergangsphasen zwischen den Gangarten ausgenommen, da die beiden Parameter hier ein sehr unterschiedliches und zeitversetztes Verhalten zeigen. Bei der Analyse der Gangarten Schritt und Trab konnte gut mit dem Modell der einfachen linearen Regression (y = a + bx) gearbeitet werden, mit Hinzukommen der dritten Gangart, Galopp, erwies sich das Modell der polynomialen Regression (y = a + bx + cx²) von Vorteil. Die Stärke des Zusammenhanges der beiden Größen wurde durch den Korrelationskoeffizienten r angezeigt. Bei differenzierter Betrachtung der Versuchsvarianten und der einzelnen Pferde erreichte r Werte von 0,86 bis 0,94, bei zusammenfassender Betrachtung aller Pferde einer Versuchsvariante Werte zwischen 0,82 und 0,87, stets bei signifikanter Korrelation (p < 0,05). Somit kann für die Parameter Herzfrequenz und Beschleunigung ein signifikanter und starker Zusammenhang beschrieben werden. Sie verhalten sich dabei nicht proportional zueinander. Schlussfolgernd lässt sich sagen, dass die Akzelerometrie für bestimmte Zielstellungen und unter bestimmten Voraussetzungen eine geeignete Methode ist, um den Energieaufwand von Pferden zu bestimmen. Sie ist schnell und meist störungsfrei durchzuführen und im Gegensatz zur Herzfrequenz nahezu unabhängig von emotionalen Einflüssen. Des Weiteren bietet die Akzelerometrie die Möglichkeit, die Ermittlung des Energieumsatzes mit einer Verhaltensanalyse zu kombinieren. Bedingungen für ihren Einsatz sind eine situationsspezifische und möglichst individuelle Kalibrierung, denn die Beschleunigungsmessung weist insofern Nachteile auf, als dass sie die Auswirkungen von zum Beispiel Bodenbeschaffenheit, Umwelteinflüssen oder das Tragen einer Last auf den Energieumsatz nicht berücksichtigt. Die parallele Erfassung von Herzfrequenz und Beschleunigung kann zum Beispiel zur Analyse und Kontrolle von Trainingserfolgen genutzt werden. Somit bringt die Kombination von Herzfrequenz- und Beschleunigungsmessung klare Vorteile.:Inhaltsverzeichnis 1 Einleitung 1 2 Literaturübersicht 3 2.1 Energiebewertung – Energiestufen 3 2.2 Nährstoffe und Verdaulichkeit 5 2.3 Energiebedarf 5 2.3.1 Erhaltungsbedarf 5 2.3.2 Leistungsbedarf 7 2.4 Ermittlung des Energieumsatzes 8 2.5 Sauerstoffpuls 12 2.6 Herzfrequenz – Sauerstoffverbrauch – Energieumsatz 14 2.7 Beschleunigungsmessung – Verhaltensanalyse bis hin zur Bestimmung des Energieumsatzes 29 3 Tiere, Material und Methoden 44 3.1 Versuchsvarianten 44 3.2 Tiere, Haltungsbedingungen, Trainingszustand 44 3.3 Versuchsorte 45 3.4 ergänzende Bemerkungen 45 3.5 Material und Technik 45 3.6 Versuchsdurchführung 46 3.7 Versuchsdesign 48 3.8 Versuchsauswertung 48 3.8.1 Zuordnung der Achsen x, y und z zu den Aufzeichnungskanälen des „Goldfinger“ 48 3.8.2 Messwerte – Herzfrequenz und Beschleunigung 49 3.8.2.1 Aufbereitung der Rohdaten 49 3.8.2.2 Vereinfachung des Datensatzes 50 3.8.2.3 Analyse der Teilbeschleunigungen 50 3.8.3 Bestimmung der Übergangsphasen 50 3.9 Statistik 51 4 Ergebnisse 54 4.1 Herzfrequenz- und Beschleunigungsmessung 54 4.1.1 Herzfrequenz während der Versuchsvorbereitung 54 4.1.2 Herzfrequenz und Beschleunigung bei Bewegung der Pferde an der Hand („geführt“) 55 4.1.3 Herzfrequenz und Beschleunigung bei freier Bewegung der Pferde („freilaufend“) 59 4.1.4 Herzfrequenz und Beschleunigung bei Bewegung der Pferde unter dem Reiter („geritten“) 60 4.1.5 Herzfrequenz und Beschleunigung im Vergleich zwischen den Versuchsvarianten 62 4.2 Beziehung zwischen Herzfrequenz und Beschleunigung 64 4.2.1 Besonderheit der Schrittphase2 71 4.3 Analyse der Übergangsphasen 74 4.4 Analyse der dreidimensionalen Beschleunigung 78 5 Diskussion 81 5.1 Diskussion der Fragestellung 81 5.2 Kritik der Methodik 82 5.2.1 Tiere und Versuchsdesign 82 5.2.2 Messtechnik 84 5.2.2.1 Herzfrequenzmessung 84 5.2.2.2 Beschleunigungsmessung 85 5.2.3 Herzfrequenz vor Versuchsbeginn 86 5.2.4 Herzfrequenz als Bezugsgröße 86 5.2.5 Datenreduktion 88 5.3 Herzfrequenz und Beschleunigung – Parameter zur Abbildung des Energieumsatzes 88 5.3.1 Vor- und Nachteile der Akzelerometrie 89 5.3.2 Charakteristika und Grenzen der Akzelerometrie 89 5.3.3 Übergangsphasen zwischen verschiedenen Leistungsanforderungen 90 5.4 Diskussion der Ergebnisse 92 5.4.1 Beziehung zwischen Herzfrequenz und Beschleunigung 94 5.4.1.1 Güte des Zusammenhangs von Herzfrequenz und Beschleunigung 94 5.4.1.2 Modell zur Beschreibung der Beziehung von Herzfrequenz und Beschleunigung 95 5.4.2 Die drei Dimensionen der Beschleunigung 97 5.5 Fazit 99 6 Zusammenfassung 101 7 Summary 103 8 Literaturverzeichnis 105 9 Anhang 118 10 Danksagung 130 / There are different opportunities to determine the consumption of energy in humans and animals. In 1780 Lavoisier used the quantity of melt water to calculate the energy loss of a guinea pig. The guinea pig was located inside a calorimeter which was surrounded by ice. The emitted heat induced the melting of the ice. At present both, indirect calorimetry that estimates energy expenditure from respiratory measurements of oxygen consumption and carbon dioxide production plus the excretion of nitrogen with the urine and the DLW-method that uses the different urinary elimination rates of the isotopes 2H and 18O are the so called “golden standard” for the calculation of energy consumption. For several years until now there has been a discussion about the heart rate-method. This method uses the correlation between heart rate and oxygen consumption for the calculation of energy expenditure. All above mentioned methods have pros and cons, especially for simple and quick every day application and for long-term studies. Therefore alternatives are searched. This dissertation examines the relation between the accelerometricly measured three-dimensional body acceleration and the heart rate in horses at different gaits. The heart rate has been used for comparison and as a reference item. It directly relates the acceleration with the oxygen consumption and thus with the energy expenditure. There have been three variants of trials. Horses were led by the hand (HD), moved freely (MF) in an enclosed oval or were ridden (R). In the HD- and MF-trials the same four horses were used, for the R-trials five other horses came into action. The trials followed different schemes with the gaits of walk, trot and gallop. At every trial three-dimensional body-acceleration with a logging frequency of 32 Hz and heart rate were measured simultaneously. The heart rate meter stored the heart rate in the smallest possible intervals of five seconds. After processing the crude data the dynamic part of the three-dimensional acceleration was calculated in form of “five-second-means”. After that the regression analysis was used to relate these acceleration data to the original heart rate data. In this process the transitional phases between the gaits were excluded because there both parameters have a highly varying and time-shifted relation. The model of simple linear regression (y = a + bx) suited well for analysing walking and trotting. With adding the third gait gallop the model of polynomial regression (y = a + bx + cx²) became more favourable. The correlation coefficient r showed the strength of the correlation between both parameters. By the separate inspection of the variants of trials and the individual horses r reached values from 0,86 to 0,94; pooling all horses of each variant of trials yields r-values from 0,82 to 0,87, always with a significant correlation (p < 0,05). Hence a significant and strong correlation can be attributed to the parameters heart rate and acceleration. They are not proportional to each other. In conclusion one can say: for specific aims and under certain conditions the accelerometry is an appropriate method to assess energy expenditure in horses. You can implement it quickly and mostly disturbance-free and in contrast to the heart rate it is nearly independent of emotional influence. Furthermore accelerometry gives the opportunity to combine the determination of the energy expenditure with the analysis of behaviour. A possibly individual and situation-specific calibration are the preconditions for its application. A setback of the accelerometry is that the effects of such factors like the condition of the ground, environmental influences or carrying weights are not taken into consideration. Simultaneous measurement of heart rate and body-acceleration can for example be used for analysing and controlling the success of training. Consequently there are clear advantages of combining the measurement of heart rate and acceleration.:Inhaltsverzeichnis 1 Einleitung 1 2 Literaturübersicht 3 2.1 Energiebewertung – Energiestufen 3 2.2 Nährstoffe und Verdaulichkeit 5 2.3 Energiebedarf 5 2.3.1 Erhaltungsbedarf 5 2.3.2 Leistungsbedarf 7 2.4 Ermittlung des Energieumsatzes 8 2.5 Sauerstoffpuls 12 2.6 Herzfrequenz – Sauerstoffverbrauch – Energieumsatz 14 2.7 Beschleunigungsmessung – Verhaltensanalyse bis hin zur Bestimmung des Energieumsatzes 29 3 Tiere, Material und Methoden 44 3.1 Versuchsvarianten 44 3.2 Tiere, Haltungsbedingungen, Trainingszustand 44 3.3 Versuchsorte 45 3.4 ergänzende Bemerkungen 45 3.5 Material und Technik 45 3.6 Versuchsdurchführung 46 3.7 Versuchsdesign 48 3.8 Versuchsauswertung 48 3.8.1 Zuordnung der Achsen x, y und z zu den Aufzeichnungskanälen des „Goldfinger“ 48 3.8.2 Messwerte – Herzfrequenz und Beschleunigung 49 3.8.2.1 Aufbereitung der Rohdaten 49 3.8.2.2 Vereinfachung des Datensatzes 50 3.8.2.3 Analyse der Teilbeschleunigungen 50 3.8.3 Bestimmung der Übergangsphasen 50 3.9 Statistik 51 4 Ergebnisse 54 4.1 Herzfrequenz- und Beschleunigungsmessung 54 4.1.1 Herzfrequenz während der Versuchsvorbereitung 54 4.1.2 Herzfrequenz und Beschleunigung bei Bewegung der Pferde an der Hand („geführt“) 55 4.1.3 Herzfrequenz und Beschleunigung bei freier Bewegung der Pferde („freilaufend“) 59 4.1.4 Herzfrequenz und Beschleunigung bei Bewegung der Pferde unter dem Reiter („geritten“) 60 4.1.5 Herzfrequenz und Beschleunigung im Vergleich zwischen den Versuchsvarianten 62 4.2 Beziehung zwischen Herzfrequenz und Beschleunigung 64 4.2.1 Besonderheit der Schrittphase2 71 4.3 Analyse der Übergangsphasen 74 4.4 Analyse der dreidimensionalen Beschleunigung 78 5 Diskussion 81 5.1 Diskussion der Fragestellung 81 5.2 Kritik der Methodik 82 5.2.1 Tiere und Versuchsdesign 82 5.2.2 Messtechnik 84 5.2.2.1 Herzfrequenzmessung 84 5.2.2.2 Beschleunigungsmessung 85 5.2.3 Herzfrequenz vor Versuchsbeginn 86 5.2.4 Herzfrequenz als Bezugsgröße 86 5.2.5 Datenreduktion 88 5.3 Herzfrequenz und Beschleunigung – Parameter zur Abbildung des Energieumsatzes 88 5.3.1 Vor- und Nachteile der Akzelerometrie 89 5.3.2 Charakteristika und Grenzen der Akzelerometrie 89 5.3.3 Übergangsphasen zwischen verschiedenen Leistungsanforderungen 90 5.4 Diskussion der Ergebnisse 92 5.4.1 Beziehung zwischen Herzfrequenz und Beschleunigung 94 5.4.1.1 Güte des Zusammenhangs von Herzfrequenz und Beschleunigung 94 5.4.1.2 Modell zur Beschreibung der Beziehung von Herzfrequenz und Beschleunigung 95 5.4.2 Die drei Dimensionen der Beschleunigung 97 5.5 Fazit 99 6 Zusammenfassung 101 7 Summary 103 8 Literaturverzeichnis 105 9 Anhang 118 10 Danksagung 130

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Yes / Background Previous research has shown that use of a dynamic-response prosthetic foot (DRF) that incorporates a small passive hydraulic ankle device (hyA-F), provides certain biomechanical benefits over using a DRF that has no ankle mechanism (rigA-F). This study investigated whether use of a hyA-F in unilateral trans-tibial amputees (UTA) additionally provides metabolic energy expenditure savings and increases the symmetry in walking kinematics, compared to rigA-F. Methods Nine active UTA completed treadmill walking trials at zero gradient (at 0.8, 1.0, 1.2, 1.4, and 1.6 of customary walking speed) and for customary walking speed only, at two angles of decline (5° and 10°). The metabolic cost of locomotion was determined using respirometry. To gain insights into the source of any metabolic savings, 3D motion capture was used to determine segment kinematics, allowing body centre of mass dynamics (BCoM), differences in inter-limb symmetry and potential for energy recovery through pendulum-like motion to be quantified for each foot type. Results During both level and decline walking, use of a hyA-F compared to rigA-F significantly reduced the total mechanical work and increased the interchange between the mechanical energies of the BCoM (recovery index), leading to a significant reduction in the metabolic energy cost of locomotion, and hence an associated increase in locomotor efficiency (p < 0.001). It also increased inter-limb symmetry (medio-lateral and progression axes, particularly when walking on a 10° decline), highlighting the improvements in gait were related to a lessening of the kinematic compensations evident when using the rigA-F. Conclusions Findings suggest that use of a DRF that incorporates a small passive hydraulic ankle device will deliver improvements in metabolic energy expenditure and kinematics and thus should provide clinically meaningful benefits to UTAs’ everyday locomotion, particularly for those who are able to walk at a range of speeds and over different terrains. / Engineering and Physical Sciences Research Council(EPSRC, reference EP/H010491/1).

No description available.

There is an increase in the prevalence of obesity among people with schizophrenia thought to be due in part to the weight enhancing side-effects of medications commonly used to treat the symptoms of schizophrenia. Despite the deleterious health effects associated with obesity and its impact on quality of life and medication compliance, little is known about body composition and energy expenditure in this clinical group. The primary purpose of this thesis was to enhance understanding of body composition and energy expenditure, particularly resting energy expenditure in men with schizophrenia who take atypical antipsychotic medications. Unique to this investigation is the evaluation of clinical tools used to predict body composition and energy expenditure against reference methodologies in men with schizophrenia. Further, given the known links between obesity and physical activity, an additional but less comprehensive component of the thesis was a consideration of total and activity energy expenditure in addition to the interaction between psychiatric symptoms, side-effects of antipsychotic medications and physical activity also occurred as part of this thesis. Collectively, the goals of this thesis were addressed through a series of studies – the first two studies were related to the measurement and characteristics of body composition in men with schizophrenia, while the third and fourth studies were related to the measurement and characteristics of resting energy expenditure in men with schizophrenia. The fifth and sixth studies the utilised doubly labelled water technique to quantify activity and total energy expenditure in a small group of men with schizophrenia and explored the use of accelerometry in this cohort. The final study briefly considered the impact of psychiatric symptoms and self-reported medication side-effects on objectively measured physical activity. In the first study, thirty-one male adults previously diagnosed with schizophrenia and sixteen healthy male controls were recruited. Estimates of body composition derived from an anthropometry-based equation and from bioelectric impedance analysis (BIA) using deuterium dilution as the reference methodology to determine total body water were compared. The study also determined the validity of equations commonly used to predict body composition from BIA in the men with schizophrenia. A further aim was to determine the superiority of either BIA or body mass index (BMI) as an indicator of obesity in this cohort. The inclusion of the control group, closely matched for age, body size and body composition demonstrated that there was no difference in the ability of body composition prediction methods to distinguish between fat and fat-free mass (FFM) in controls and men with schizophrenia when both groups had similar body composition. However this study indicated that an anthropometry-based equation previously used in people with schizophrenia was a poor predictor of body composition in this cohort, as evidenced by wide limits of agreement (25%) and systematic variation of the bias. In comparison, the best predictor of percentage body fat (%BF) in this group was gained when impedance values were used to predict percentage body fat via the equation published by Lukaski et al (1986). Although percentage body fat was underpredicted using the Lukaski et al. (1986) equation, the mean magnitude was relatively small (1.3%), with the limits of agreement approximately 13%. Linear regression analysis revealed that %BF predicted using the Lukaski et al. (1986) equation explained 25% more of the variance in percentage body fat than BMI. Further, this study also indicated that BIA was more sensitive than BMI in distinguishing between overweight and obesity in this cohort of men with schizophrenia. Because of the almost exclusive use of BMI as an indicator of obesity in people with schizophrenia, the level of excess body fat may be in excess of that previously indicated. The second study extended the examination of body composition in men with schizophrenia. In this study, the thirty-one participants with schizophrenia (age, 34.2 ± 5.7 years; BMI, 30.2 ± 5.7 kg/m2) were individually matched with sedentary controls by age, weight and BMI. Deuterium dilution was used to distinguish between FFM and fat mass. The previous study had indicated that while BIA was a suitable group measure for obesity, on an individual level the technique lacked the precision required for investigating body composition in men with schizophrenia. Waist circumference was used as an indicator of body fat distribution. The findings of this study indicated that in comparison with healthy sedentary controls of similar body size and age, men with schizophrenia had higher levels of body fat which was more centrally distributed. Percentage body fat was on average 4% higher and waist circumference, on average 5 cm greater in men with schizophrenia than the sedentary controls of the same age and BMI. Further, this study indicates that the use of BMI to predict body fat in men with schizophrenia will result in greater bias than when it is used to predict body fat in other sedentary men. Commonly used regression equations to predict energy requirements at rest are based on the relationships between weight and resting energy expenditure (REE) and in such equations, weight acts as a surrogate measure of FFM. The objectives of study three were to measure REE in a small group of men with schizophrenia who were taking the antipsychotic medication clozapine and to determine whether REE can be predicted with sufficient accuracy to substitute for the measurement of REE in the clinical and/or research settings. Body composition was determined using deuterium dilution and REE was measured using a Deltatrac Metabolic Cart via a ventilated hood. The male participants, (aged 28.0 ± 6.7 yrs, BMI 29.8 ± 6.8 kg/m2) were weight stable at the time of the study and had been taking clozapine for 20.5 ± 12.8 months, with doses of 450 ± 140 mg/day. Of the six prediction equations evaluated, the equation of Mifflin et al. (1990) with no systematic bias, the lowest bias and the lowest limits of agreement proved to be the most suitable equation to predict REE in this cohort. The overestimation of REE can be corrected for by deducting 160 kcal/day from the predicted REE value when using the Mifflin et al. (1990) equations. However, the magnitude of the error associated with the prediction of REE for an individual is 370 kcal/day. The findings of this study indicate that REE cannot be predicted with sufficient individual accuracy in men with schizophrenia, therefore it was necessary to measure rather than predict REE in subsequent studies. In the fourth study, indirect calorimetry (Deltatrac Metabolic Cart via ventilated hood) and deuterium dilution were used to accurately determine REE, respiratory quotient (RQ) and FFM in 31 men with schizophrenia and healthy sedentary controls individually matched for age and BMI. Data from this study indicated that gross REE was lower in men with schizophrenia than in healthy sedentary controls of a similar age and body size. However, there was no difference between the groups in REE when REE was adjusted for FFM using the mathematically correct method (analysis of covariance with FFM as the covariate). There was however a statistically and clinically significant difference in resting, fasted RQ between men with schizophrenia and controls, suggesting that RQ rather than REE may be an important correlate worthy of further investigation in men with schizophrenia who take antipsychotic medications. Studies five and six involved the application of the doubly labelled water (DLW) technique to accurately determine total energy expenditure (TEE) and activity energy expenditure (AEE) in a small group of men with schizophrenia who had been taking the atypical antipsychotic medication clozapine. The participants were those who took part in study three. The purpose of these studies was to assess the validity of a commercially available tri-axial accelerometer (RT3) for predicting free-living AEE and to investigate TEE and AEE in men with schizophrenia. There was poor agreement between AEE measured using DLW and AEE predicted using the RT3. However, using the RT3 to measure inactivity explained over two-thirds of the variance in AEE. This study found that the relationship between current AEE per kilogram of body weight and change from baseline weight in men taking clozapine was strong although not significant. The sedentary nature of the group of participants in this study was reflected in physical activity levels, (PAL, 1.39 ± 0.27), AEE (435 ±352 kcal/day) and TEE (2511 ± 606 kcal/day) that fell well short of values recommended by WHO (2000) for optimal health and to prevent weight gain. Given the increasing recognition of the importance of sedentary behaviour to weight gain in the general community, further examination of the unique contributing factors such as medication side effects and symptoms of mental illness to activity levels in this clinical group is warranted. The final study used accelerometry (RT3) to objectively measure activity in a group of 31 men with schizophrenia who had been taking atypical antipsychotic medications for more than four months. The purpose of this study was to explore the relationships between psychiatric symptomatology, side-effects of medication and physical activity. Accelerometry output was analysed to provide a measure of inactivity and moderate intensity activity (MIA). The well-validated and reliable standardised clinical interview, the Positive and Negative Syndrome Scale (PANSS) was used as a measure of psychiatric symptoms. Perceived side-effects of medication were assessed using the Liverpool University Neuroleptic Rating Side-Effects Scale (LUNSER). Surprisingly, there was no relationship reported between any measures of negative symptoms and physical inactivity. However, self-reported measures of medication side-effects relating to fatigue, sleepiness during the day and extrapyramidal symptoms explained 40% of the variance in inactivity. This study found significant relationships between some negative symptoms and moderate intensity activity. Despite the expectation that as symptoms of mental illness reduce, inactivity may diminish and moderate intensity activity will increase, it may not be surprising that in practice this is an overly simplistic view. It may be that measures of social functioning and possibly therefore cognition may be better predictors of physical activity than psychiatric symptomatology per se.

Avaliar acuradamente o gasto energético de repouso (GER) é de extrema importância no suporte nutricional e a análise de composição corporal influencia seu valor. O estudo teve como objetivos desenvolver equações preditivas de GER por meio de dados de composição corporal obtidos por exame de bioimpedância eléctrica multifrequencial por espectroscopia (BIS); avaliar a adequação das fórmulas mais usuais de predição do GER; medir a correlação dos parâmetros gerados por BIS com o GER, analisar a concordância e a correlação dos dados gerados pelos aparelhos de bioimpedância de frequência simples (BIA) e BIS, além da concordância entre os métodos de classificação do estado nutricional por Índice de Massa Corporal (IMC) e por %MG (Porcentual de Massa Gorda) avaliada por BIA e BIS. Caracterizou-se como um estudo transversal observacional desenvolvido com brasileiros saudáveis, ambos os sexos, entre 20 e 40 anos de idade, estratificados em subgrupos pelo IMC (subnutrido, n=40; eutrófico, n=120; com sobrepeso, n=118 e com obesidade, n=114) e pelo %MG (baixa gordura, n=17; gordura adequada, n=101; excesso de gordura, n=91 e obesidade, n=183). O GER foi medido por calorimetria indireta (CI). Houve emprego do teste de correlação de Spearman e de Pearson e do gráfico de dispersão para avaliar as associações entre as variáveis e de modelos de regressão linear múltipla no desenvolvimento das equações, por método Stepwise. Aplicou-se o teste de BlandAltman, o coeficiente de correlação intraclasse, o teste de Wilcoxon e o coeficiente de correlação kappa para análise de concordância entre medidas e classificações e o teste de Mann-Whitney e Kruskal-Wallis para comparação entre os subgrupos (p<0,05). O GER predito foi considerado adequado quando se encontrou entre 90 e 110% do GER medido por CI. Desenvolveu-se uma equação para a amostra total por sexo e uma para cada categoria do IMC e do %MG e as mesmas apresentaram baixos valores de coeficientes de determinação (R2). As maiores correlações entre as variáveis independentes com o GER ocorreram para o peso, IMC, Massa Gorda7 (MG) e Massa de Tecido Adiposo. Todas as equações usuais avaliadas não foram capazes de predizer corretamente o GER em metade da amostra. As classificações do estado nutricional realizadas por meio do IMC e %MGBIA obtiveram concordância fraca com aquela por %MGBIS. A concordância entre BIA e BIS foi baixa: tecidos corporais de maior hidratação foram superestimados e os menos hidratados subestimados, por BIA frente a BIS, e os vieses entre os dois equipamentos foram maiores com o aumento do IMC. Assim, as equações desenvolvidas apresentaram baixo R2, impossibilitando sua aplicação no cenário clínico. Já as equações de predição do GER avaliadas exibiram baixa adequação, não se recomendando seu uso. A classificação do estado nutricional por meio do IMC subestima as quantidades de MG, sendo mais adequada a utilização de composição corporal para caracterização nutricional. BIA e BIS geram resultados distintos: o tamanho corporal aparece como um fator de confusão na distinção das massas corporais analisadas, mas, a distribuição e a quantidade de água corporal total apresentam-se como fatores limitantes de maior força / The accurate assessment of resting energy expenditure (REE) is extremely important in nutritional support for energy supply adjustment and body composition analysis plays a significant role in determining its value. The objectives of this thesis was to develop prediction equations of REE using body composition assessment data by bioelectrical impedance; assess the adequacy of the more usual prediction equations of REE against the measured value; measuring the correlation of the parameters generated by multifrequency spectroscopy bioelectrical impedance (BIS) in GER and analyze the agreement and correlation of data generated by bioelectrical impedance devices of simple frequency (BIA) and (BIS), in total sample and between subgroups stratified by body mass index (BMI) and body fat percentage (%BF), in addition to assess the agreement between the classification of nutritional state by BMI and %BF generated by BIA and BIS . This was an observational cross-sectional study with healthy Brazilians, both sexes, between 20 and 40 years old, stratified into subgroups by BMI (malnourished, n=40; eutrophic, n=120; overweight, n=118 and obese, n=114) and by %BF (low fat, n=17; suitable fat, n=101; excess fat, n=91 and obesity, n=183). There was the use of anthropometric and epidemiological parameters and those generated by BIS analysis in the equations\'s development. REE was measured by indirect calorimetry (IC). Employment Spearman correlation test and scatterplot to assess the associations between the variables and multiple linear regression models in the development of the equations. Application of Bland-Altman analysis, intraclass correlation coefficient, Wilcoxon test and kappa correlation coefficient for agreement analysis between measurements and classifications and the Mann-Whitney and Kruskal-Wallis test to compare the subgroups (p <0,05). Thus, an equation was developed for the total female sample and one for each of the last three categories of BMI and% BF, the same for males. The equations obtain low values of determination coefficient (R2). The highest correlations between the independent variables with REE occurred, for both females and males, with weight, BMI, BF and9 Adipose Tissue Mass. All the usual equations evaluated had low accuracy since none was able to correctly predict GER in 50% or more of the sample, either for the whole sample or stratified by BMI and %BF. The equations with the highest percentages of the sample within the adequacy limits were Owens, Henry-Rees and Livingston-Kohlstadt 2. The worst percentages of the sample within the adequacy limits were those of Ireton-Jones, FAO/WHO/UN 2 and Frankenfield 1. The nutritional status rankings performed through BMI and %BFBIA obtained weak agreement with that by %BFBIS, tending to classify the individual one or two levels below, underestimating the presence of %BF. The agreement between BIA and BIS was low since the equipment presented different results for all the variables, either in the total sample or in the stratified subgroups. The BIA against BIS underestimated the amounts related to the BF and total body water variables and overestimated those concerning the FFM and BCM. The biases between the two equipments were greater with the increase of BMI. Thus, the developed equations have low R2, which makes it impossible to apply them in the clinical setting. The most common and predictive GER prediction equations presented low accuracy, not proving to be adequate for use in clinical practice. The classification of nutritional status through BMI results in errors that compromise the approach of nutritional therapy, underestimating the amounts of BF and its deleterious potencies, so it is more appropriate to evaluate it through body composition. BIA and BIS generate different results, and body size appears as a confounding factor in the body mass distinction analyzed by BIA, but the distribution and amount of total body water is a limiting factor of greater strength for the BIA

Com o objetivo de conhecer a prática alimentar, a atividade fÍsICA e o gasto energético de adolescentes, de ambos os sexos, inseridos ou não no mercado de trabalho, administraram-se questionários auto-aplicáveis a 273 estudantes, do período noturno, de seis escolas da Rede Estadual de Ensino de Santo André - SP. Estudantes trabalhadores (163) , ou seja, que recebiam remuneração por serviços prestados, mantinham-se em atividades ocupacionais pelo período de 40 a 50 horas semanais, percebendo de 1 a 3 salários mínimos por mês. Os meninos participavam, proporcionalmente, mais no mercado de trabalho formal que as meninas. Foram relatadas todas as atividades fisicas desempenhadas segundo número de dias por semana e horas por dia. Entre as várias atividades discriminadas, destacou-se assistir televisão, como prática comum a todos os estudantes, independentemente de gênero e de inserção ou não no trabalho. Outras atividades assinaladas mostraram-se estatisticamente independentes do fato de trabalhar ou não, porém, foi detectada, para algumas, associação com gênero, tais como prática esportiva (meninos) e afazeres domésticos (meninas) . O gasto energético diário referente à atividade física foi estimado com base nos diferentes movimentos, ponderados por tempo e nos fatores atividades da FAO/OMS/UNU. Os valores encontrados foram 3150 e 2160 Cal para estudantes masculinos e femininos, respectivamente. A prática alimentar foi analisada sob o aspecto qualitativo da dieta habitual, utilizando, como padrão, uma adaptação do Food Guide pyramid. Não foram observadas associações estatisticamente significativas entre trabalhar e apresentar dieta inadequada para os grupos de alimento de carnes e de cereais, ao contrário do verificado entre os grupos de frutas e de verduras, cujo teste estatístico indicou haver associação. / A group of 273 students of evening courses of 6 State Public schools, located in the city of Santo André, State of São Paulo, Brazil, was analyzed, aiming to know their dietary practices, physical activities and energy expenditures. One hundred and sixty three adolescents were workers and their occupational activities last for 40 to 50 hours per week; they earned from 1 to 3 living wages. Proportionally, male adolescents were more engaged in the formal workmanship than girls. All their physical activities were described and draw the attention \"watching TV\" as the most frequent for both sexes and workers or not. Other activities were statistically associated to gender but independent to the fact of being a worker (boys were more related to sports and girls to housekeeping). The daily energy expenditure related to physical activities was calculated based on the FAO/WHO/UNU movement-factors indicators, and the values of 3000 and 2100 Cal were estimated for boys and girls, respectively. Dietary practices, by the point of view of quality, were analyzed, using one adaptation of the Food Guide Pyramid. Statistical association was not found between inadequate diets and workers when meat and cereals were observed; the opposite occurred when fruits and vegetables were taken in account, statistical association was detected.