1Depa men o Physiology and Pa hophysiology, Medical Facul y, Uni e si y o Os a a, Os a a, Czech Republic; 2Depa men o Physiology, Medical Facul y, Masa yk Uni e si y,
B no,CzechRepublic; 3Vascula andMiniin asi eSu ge yCen e ,Hospi alAGELT inec-Podlesi,T inec,CzechRepublic; 4HumanMo emen Diagnos icCen e ,Uni e si yo Os a a,
Os a a, Czech Republic; 5Depa men o Cybe ne ics and Biomedical Enginee ing, Facul y o Elec ical Enginee ing and Compu e Science, VSB - Technical Uni e si y o Os a a,
Os a a, Czech Republic; 6Ins i u e o Labo a o y Medicine, Medical Facul y, Uni e si y o Os a a, Os a a, Czech Republic; 7Depa men o Su ge y, Cen e o Ba ia ic Medicine,
Hospi al AGEL - Os a a - Vi ko ice, Os a a, Czech Republic; 8Depa men o Su gical Disciplines, Medical Facul y, Uni e si y o Os a a, Os a a, Czech Republic.
∗Co espondence o Ma ej Peka : [email p o ec ed]
DOI: 10.17305/bjbms.2022.7786
© 2022 Buˇ
zga e al. This a icle is a ailable unde a C ea i e Commons License (A ibu ion 4.0 In e na ional, as desc ibed a h ps://c ea i ecommons.o g/licenses/by/4.0/).
Biomolecules and Biomedicine, 2023, Vol. 23, No. 2, 191–197 191 www.biomolbiomed.com
SPECIAL ARTICLE
P e en ion o sa copenia in pa ien s wi h obesi y a e
ba ia ic and me abolic su ge y: The effec o
p og ammed aining on he muscle issue and
an h opome ic unc ions—A andomized con olled
ial (Sa xOb s udy p o ocol)
Ma ek Buˇzga 1, Ma ej Pekaˇ
2,3∗, Ja osla Uchy il4, Ve onika Ho ká 4, Jan Mal˚
uˇ
s4, Dominik Vilímek5, Zdenˇ
ek ˇ
S age a 6,
Pe Ku áˇ
c4, and Pa ol Holéczy7,8
Obesi y is a se ious me abolic disease ha significan ly inc eases ca dio ascula isks and o he heal h complica ions. Sa copenia is an
independen isk ac o o mo bidi y and mo ali y in pa ien s suffe ing om obesi y ha inc eases he heal h isks and is associa ed
wi h ca diac, espi a o y, and o he diseases. Ba ia ic and me abolic su ge y (BMS) leads o significan changes in body composi ion.
Ou pilo s udy showed ha ba ia ic pa ien s a e a isk o sa copenia a e BMS. This finding esul ed in a hypo hesis ha an exe cise
plan in he expe imen al g oup will lead o pos u al s abiliza ion and a lowe decline in muscle homo opy, u he leading o a g ea e
educ ion in a mass and a posi i e effec o exe cise on skele al muscle olume and s eng h and endoc ine-me abolic unc ion. The
aim o he p esen s udy is o de e mine he effec o p og ammed ae obic and s eng h aining on muscle unc ion, olume, and
mo phology in pa ien s a e BMS. The s udy is a single-cen e , andomized clinical ial a e slee e gas ec omy ocused on muscle
issue. The expe imen al g oup will pe o m a ge ed physical ac i i y once a week o 12 mon hs and he aining plan will include
anae obic and ae obic componen s. Magne ic esonance imaging o skele al muscles will be co ela ed wi h he alues o densi ome y
examina ion and changes in body composi ion, ce ain blood pa ame e s o myokines, biomechanical analysis o mo emen
abno mali ies, and beha io al and die a y counseling. This s udy will add ess he esea ch ques ions abou he effec o p og ammed
aining on muscle issue and muscula unc ions a e BMS.
Keywo ds: Sa copenia, exe cise, ba ia ic, me abolic, su ge y.
In oduc ion
O e he pas wo decades, obesi y has become a se ious global
heal h p oblem. In Cen al and Eas e n Eu ope, he p e alence
o obesi y s ands as a o e on issue in all epidemiological
s udies [1,2]. Since he end o he 1990s, su gical ea men
(BMS) has been shown o be he mos e ec i e ea men o
obesi y [3]. Unlike conse a i e ea men (li es yle changes,
balanced die a y in ake, physical ac i i y, and pha maceu ical
he apy), which ails in mo e han 80% o pa ien s o e he long
e m, me abolic su ge y esul s in long- e m success in mo e
han 80% o pa ien s [4].
Pa ien s wi h obesi y a e also a isk o como bidi ies, such
as ype II diabe es, hepa ic s ea osis, hype ension, sa copenic
obesi y, and o he s. The combina ion o low muscle mass and
low s eng h wi h inc eased a mass may u he agg a a e,
me abolic diso de s and physical disabili y wi h a syne gis ic
e ec [5]. Common guidelines issued by he Ame ican Socie y
o Me abolic and Ba ia ic Su ge y, he Obesi y Socie y, and
he Ame ican Associa ion o Clinical Endoc inologis s ecom-
mend ha pos ope a i e pa ien s adhe e o a heal h ul li es yle
ha includes exe cise o a leas 30 min•pe day [6].
Ou pilo s udy published in 2020 showed ha a e BMS,
pa ien s a e a isk o de eloping sa copenia. BMS leads o sig-
ni ican changes in body composi ion. Signi ican a loss is also
ollowed by unin ended muscle loss. The combina ion o low
muscle mass and s eng h wi h inc eased a mass in il a ion,
known as sa copenic obesi y, may ha e a syne gis ic e ec ,
u he agg a a ingo me abolicdiso de sandphysicaldisabil-
i y. A key pa hophysiological mechanism in he e iology o his
p oblem is he in lamma o y ac i i y o he excessi e a is-
sue. Mo eo e , sa copenia in obese subjec s is associa ed wi h
a highe isk o hype ension, a e ial s i ness, dyslipidemia,
insulin esis ance, knee a h i is, and os eopo osis, inc easing
he isk o alls and ac u e and di icul ies wi h physical unc-
ion. I was ound ha he lack o physical ac i i y ypical o
hese pa ien s con ibu es o his e ec [7].
The e o e, he e is a need o u he esea ch o elucida e
he pa hophysiological mechanism esponsible o sa copenic
obesi y and he e ec o exe cise on muscle issue in pa ien s
a e BMS. P e ious s udies in his a ea ha e ocused on he
e ec o exe cise and weigh loss a e BMS on imp o ing
como bidi y pa ame e s [8]. Howe e , mos o hese s udies
had an inadequa ely desc ibed exe cise plan and de ini ion o
exe cisein e en ion.Cu en ly, he ea eonly wos udies ha
ha e in es iga ed physical ac i i y, exe cise plans and in e -
en ion in pa ien s in he pos ope a i e pe iod in de ail [9,10].
The p esen s udy plans o in es iga e he ela ionship
be ween muscle ac i i y in pa ien s wi h obesi y and he
e ec o long- e m exe cise, he e ec o weigh educ ion
on muscle issue, he pa hophysiology o myokines a ec ing
ca bohyd a e me abolism, and inally, he e ec o weigh
educ ion on musculoskele al unc ion. Such a comp ehensi e
pa hophysiological s udy using igo ous me hods o assess he
pa hophysiology o muscle issue, he musculoskele al sys em,
and he e ec o exe cise has no beenca ied ou . This esea ch
is especially impo an gi en he expec ed inc ease in he
p e alenceo obesi yand sa copenia o e henex 20yea s [11].
Hypo hesis and esea ch aims
Hypo hesis
I. The inclusion o an exe cise plan in he in e en-
ion g oup will lead o he s abiliza ion o pos u e
and a dec ease in muscle homo opy compa ed o he
non-exe cise plan g oup.
II. The e ec o exe cise will esul in a g ea e educ ion in
a mass and a posi i e e ec on skele al muscle olume,
s eng h, and endoc ine-me abolic unc ion.
III. Regula exe cise in he in e en ion g oup will inc ease
gai s abili y and educe he isk o alls compa ed o he
non-exe cise plan g oup.
Aims o he p ospec i e s udy
a. To de e mine he e ec o p og ammed ae obic and
s eng h aining on muscle unc ion, olume, and
mo phology in pa ien s a e BMS.
b. To de e mine he e ec o weigh educ ion on he a ic-
ula ca ilage o he knee join and o de e mine he e ec
o weigh educ ion on biomechanical mo emen pa am-
e e s associa ed wi h os eoa h i is o he weigh -bea ing
lowe limb join s.
c. To de e mine he changes in se um le els o biochemical
nu i ional pa ame e s associa ed wi h skele al muscle.
d. To de e mine he imp o emen om baseline quali y o
li e as measu ed by he Impac o Weigh on Quali y o
Li e ques ionnai e (IWQOL) and he 36-I em Sho Fo m
Su ey (SF-36).
Ma e ials and me hods
This is a p ospec i e andomized clinical ial aimed a
examining and assessing changes in muscle, me abolic muscle
p ocesses, and locomo ion a e BMS o e he cou se o
18 mon hs. Pa icipan s will be andomly assigned o he
expe imen al o con ol g oups. Blinding o he s udy g oups is
no possible due o he ype o in e en ion (exe cise p og am).
The pa ien s will unde go he su gical p ocedu e a he Cen e
o Ba ia ic Medicine, Hospi al AGEL – Os a a-Vi ko ice,
and he s udy isi s will be pe o med a he Human Mo e-
men Diagnos ic Cen e a he Uni e si y o Os a a, Czech
Republic.
Slee e gas ec omy
Slee e gas ec omy will be ca ied ou using lapa oscopic
su ge y as desc ibed in ou p e ious s udy [12]. The p ocedu e
is expec ed o be he same in he wo g oups (con ol s.
expe imen al).
Con ol g oup (usual ca e)
Pa icipan s in bo h g oups will unde go a pos ope a i e
ollow-up ou inely p esc ibed a he Cen e o Ba ia ic
medicine, acco ding o he in e na ional s anda ds [13]. Du ing
he i s ou weeks, all pa ien s will main ain a semi-liquid
die . Medical consul a ions will be scheduled 1, 3, 6, 9, 12,
and 18 mon hs a e su ge y, wi h special a en ion paid o
nu i ionals a us.Usualca ea e BMSincludes egula clinical
checks by specialis s (su geon, nu i ional specialis ), as well as
a se o ecommenda ions o physical ac i i y. The pa ien s
a e su ge y ha e he op ion o exe cise in he swimming
pool, on an exe cise bike and eadmill o using o he i ness
machines a he gym. Howe e , he exe cise is no manda o y.
A e he end o he s udy, con ol pa ien s will be o e ed he
same s anda d exe cise in e en ion egimen as hose in he
expe imen al g oup.
Expe imen al g oup (usual ca e +supe ised exe cise)
The expe imen al g oup will pe o m a ge ed physical ac i i y
onceaweek o 12mon hsunde hesupe isiono aspecialized
i ness aine . The op imal equency o physical ac i i y is 2–3
imes a week. Howe e , ou p ima y goal is o p o ide a basic
da abase o exe cises and o check hei co ec execu ion. We
s i e o as easible s udy design. Conside ing he di e en
imeso en yin o hes udyo eachpa icipan ,i isno possible
(economically and ime-wise) o equi e a con olled physical
ac i i y session mo e han once a week. Each pa icipan in he
expe imen al g oup will unde go 12 mon hs o a ge ed phys-
ical ac i i y and six ollow-up measu emen s o e 18 mon hs
(Figu e 1).
Ta ge ed physical ac i i y will be pe o med unde he
supe ision o a specialized i ness aine . The aining plan
will be di ided in o a o al o eigh phases including a 5 min
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Sa xOb ial p o ocol 192 www.biomolbiomed.com
Figu e 1. Timeline o in e en ions and ollow-up o pa icipan s en olled in he s udy. The figu e ep esen s he s udy measu emen s du ing specific
in e als ha a e shown ch onologically.
wa m-up ( eadmill), 5 min o b ea hing exe cises, a 15–30 min
s eng hcomponen ( esis ancebandsanddumbbellexe cises),
10–20 min o ae obic ac i i y (exe cise bike and eadmill), and
a 10 min o inal s e ching. The es ima ed aining ime is 50–
60 min, ne e exceeding he 60-min limi . The du a ion o he
wo kou will depend on he phase, which is ocused on mobili y
and compensa o y exe cises, s eng hening pos u al muscles
wi h body weigh , ae obic endu ance, and s eng hening
smalle and hen la ge muscles. A p ecise schedule o speci ic
exe cises will be c ea ed o he in e en ion and con olled by
he numbe and equency o epe i ions, which will be limi ed
by ime. The indi idual load will be de e mined by esis ance
bands (5, 10, and 15 kg) and weigh s o 7.5 and 12.5 kg. The
p o ocol o heo e allexe ciseplan o heexpe imen alg oup
is p o ided in Table 1.
S udy isi and ollow-up
Du ing he ollow-up pe iod, pa ien s en olled in he s udy will
bemoni o edbyamul idisciplina y eam ha includesba ia ic
su geons, endoc inologis s, nu i ionis s, psychologis s, and
physio he apis s. Pa ien s ul illing he inclusion c i e ia and
wi hou exclusion c i e ia cha ac e is ics (Table 2) will be
o e ed o pa icipa e in he s udy. Be o e inclusion, all pa ien s
will ha e o ead and sign he in o med consen o m. The
pa icipan swillha e ollow-upclinic isi sspeci ic o hes udy
a 45 days (o ewe ) be o e he su gical p ocedu e (baseline
isi ) and ollow-up clinic isi s a 1, 3, 6, 12, and 18 mon hs
a e he su gical p ocedu e (Table 3 and Figu e 1).
Da a collec ion
Medical his o y: A each isi , he in es iga o will eco d de ails
o medicalandsu gicalhis o yand hei changes,pe o mmed-
ica ion e iew, and d aw a blood sample o pe o m s anda d
labo a o y es ing o he ollowing:
1. Glucose, glyca ed haemoglobin, alkaline phospha ase,
o al calcium, phospha e, pa a hy oid ho mone, o al
p o ein, albumin, aspa a e amino ans e ase, alanine
amino ans e ase,gammaglu amyl ans e ase, and c e-
a inine. Analyses will be pe o med on A elica Solu ion,
Siemens, USA.
2. A e comple ing he e alua ion o hese analy es, se um
(plasma) aliquo s will be ozen a −80 °C un il u he
analysis o o he selec ed pa ame e s, such as myokines
(FGF21, IL15, IL8, and LIF). Se um le els o a ge ho -
mones and cy okines will be measu ed on a Bio-Plex®
MAGPIX™ ins umen (BioRad, He cules, CA, USA) wi h
heMILLIPLEXMAPHumanGu andMe abolicHo mone
Panel (Me ck KGaA, Da ms ad , Ge many). Ho mones
and cy okines in a issue om all pa ien s will be ana-
lyzed du ing he same es ing session.
Magne ic esonance imaging (MRI) and dual-emission X- ay
abso p iome y (DXA)
MRI: Da a will be measu ed be o e and 3, 6, 12, and 18 mon hs
a e BMS on a 1.5 T Siemens Magne om Semp a Scanne
(Siemens,E lange ,Ge many).A12-channel ecei ingkneecoil
will be used o acqui e he images and MR elaxome y T2 map-
ping will be pe o med on he knee ca ilage. The high muscle
will be scanned using a six-channel body coil wi h T1, T2, and
Dixon sequences o image adipose issue. The imaging pa am-
e e s will be as ollows: epe i ion ime/echo ime ((TE)/1TE),
ield o iew (mm3), acqui ed oxel size (mm3), econs uc ed
oxel size (mm3), and lip angle (deg ees). Da a will be acqui ed
du ing one b ea hhold. P o on densi y a ac ion (PDFF) maps
o he de e mina ion o muscle a con en will be econ-
s uc ed di ec ly on he image console a e image acquisi ion
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Sa xOb ial p o ocol 193 www.biomolbiomed.com
Table 1. Supe ised exe cise p o ocol. Ta ge ed physical ac i i y once a week o 12 mon hs wi h a o al o eigh phases, including a wa m-up
( eadmill), b ea hing exe cises, a s eng h componen ( esis ance bands and dumbbell exe cises), an ae obic po ion (exe cise bike and eadmill),
and a final s e ching
Table 2. S udy inclusion and exclusion c i e ia. Pa ien s ulfilling inclusion c i e ia and wi hou exclusion c i e ia cha ac e is ics will
be offe ed o pa icipa e in he s udy. The e will be 20 pa ien s in each g oup (con ol s. expe imen al)
Inclusion c i e ia Exclusion c i e ia
Age 18–65 yea s a sc eening Diagnosis o ype 2 diabe es less han six mon hs be o e sc eening
Body mass index 35–50 Ongoing sys emic in ec ion
Gende : emale/male His o y o o suspec ed gas oin es inal disease (e.g., ci hosis,
inflamma o y bowel disease)
Abili y o unde s and he con en o he in o med consen o m Ch onic panc ea i is
Pa ien esides wi hin 100 km o he cen e Ch onic li e disease o any cause
Tole a ed como bidi ies Poo ly con olled psychia ic disease (e.g., ongoing majo dep ession,
schizoph enia, bo de line pe sonali y, suicidali y, and psychosis)
T ea ed hype ension His o y o ea ing diso de wi hin he pas fi e yea s
T ea ed dyslipidemia P e-exis ing se e e como bid ca dio- espi a o y disease (e.g.,
conges i e hea ailu e, ca diac a hy hmia, co ona y a e y disease,
ch onic obs uc i e lung disease, and pulmona y embolism)
Uncon olled hype ension (sys olic blood p essu e >150 mm Hg o
dias olic blood p essu e >100 mm Hg)
using endo -speci ic so wa e. Skele al muscle analysis will
use an in-house ool w i en in MATLAB (The Ma hwo ks,
Na ick, MA, USA). C oss-sec ional a eas o he emo al skele al
muscles will also be ob ained. MRI muscle a in il a ion
will be assessed by mean adiodensi y in Houns ield uni s
(HU) and p o on densi y a ac ion (MRIPDFF), espec i ely
(Tables 4 and 5).
DXA: Body composi ion will be assessed in all pa icipan s
using he DXA me hod (Disco e y A; Hologic, Wal ham,
MA, USA). The ollowing pa ame e s will be moni o ed:
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Sa xOb ial p o ocol 194 www.biomolbiomed.com
Table 3. The flowcha o in e en ions and ollow-up o pa icipan s en olled in he s udy. This able depic s he schedule o
in e en ions a baseline and ollow-up
Baseline Follow-up
<45 days be o e su ge y Mon h 1 Mon h 3 Mon h 6 Mon h 12 Mon h 18
Clinical assessmen x x x x
Sc eening and sa e y exam x x x x x x
MRI and DXA x x x x x
Biomechanics exam x x x x x
Psychological assessmen x x
IWQOL; SF-36 x x x x x x
Nu i ion consul a ion x x x x x x
MRI: Magne ic esonance imaging; DXA: Dual-emission X- ay abso p iome y; IWQOL: Impac o weigh on Quali y o Li e Ques ionnai e;
SF-36: 36-I em sho o m su ey.
Table 4. Knee MRI pa ame e s. The able depic s de aul MRI sequence pa ame e s o he knee
Sequence TR/TE (ms) Flip Angle (°)
Slice Thickness
(mm) FOV (mm2) Ma ix Size
Bandwid h
(Hz/pixel)
No. o
Slices
Acquisi ion
Time (min:s)
Axial PD TSE FS 4510/27 150 3 148×148 256×198 142 30 2:08
Co onal T1 SE 490/12 150 3.2 160×160 320×223 150 28 1:36
Co onal PD TSE FS 5760/25 150 3 160×160 320×235 145 35 2:08
Sagi al T2 3D-DESS WE 18/7.05 25 0.6 150×150 256×230 260 160 3:41
Sagi al PD TSE FS 4250/26 150 3 160×160 320×212 140 30 2:09
Sagi al T2 MAP 1690/12, 24,
36, 48, 60
180 3 160×160 256×256 230 18 3:55
TSE: Tu bo spin echo; SE: Spin echo; PD: P o on densi y; FS: Fa -sa ; DESS: Double echo s eady s a e; WE: Wa e exci a ion; TR: Repe i ion ime; TE: Echo
ime; FOV: Field o iew.
Table 5. Thigh MRI pa ame e s. The able depic s de aul MRI sequence pa ame e s o he high
Sequence TR/TE (ms) Flip Angle (°)
Slice Thickness
(mm) FOV (mm2) Ma ix Size
Bandwid h
(Hz/pixel)
No. o
Slices
Acquisi ion
Time (min:s)
Co onal T1 TSE 1120/12 150 4 299×400 384×288 150 35 4:55
Axial T1 TSE 874/11 150 4 320×240 240×320 178 50 3:34
Axial PD TSE FS 3000/28 150 5 250×250 320×256 111 28 4:38
Axial T2 TSE 6500/59 150 5 250×250 320×256 200 28 2:38
Axial T1 VIBE Dixon 6.74/2.40,
4.35
10 3 217×290 288×216 500 88 5:19
TSE: Tu bo spin echo; PD: P o on densi y; FS: Fa -sa ; VIBE: Volume ic in e pola ed b ea h-hold examina ion; TR: Repe i ion ime; TE: Echo ime; FOV:
Field o iew.
a mass (kg), a (%), es ima ed isce al adipose a ea (EST
VAT; cm2), lean body mass (LBM; kg), appendage lean mass
index (ALMI; kg/m2), and lean mass index (LMI; kg/m2). The
densi ome e willbecalib a edacco ding o hemanu ac u e ’s
ecommenda ionsandins umen p ecisionwillbees ablished.
Body heigh (BH) and body mass (BM) will be measu ed
as inpu pa ame e s o bone densi ome e so wa e using an
InBody BSM 370 s adiome e (Biospace, Sou h Ko ea).
Biomechanical analysis o mo emen
The kinema ic analysis will be pe o med using 10 Qualisys
Oqus in a ed came as (9×Oqus 700+and 1×Oqus 510+,
Qualisys, Inc., Go henbu g, Sweden) wi h a scanning equency
o 240 Hz, which will hen be synch onized wi h h ee
Kis le dynamome e pla o ms (Kis le 9286AA, 9281CA and
9287CCAQ02, Kis le Ins umen s AG, Win e hu , Swi ze -
land). Wi eless pho ocells (OPZZ, EGMedical s. .o., B no, Czech
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Sa xOb ial p o ocol 195 www.biomolbiomed.com

Republic)placeda a dis ance o 3mapa willbeused o con ol
he walking speed o he es subjec while passing h ough he
o ce pla o ms.
Moni o ing o physical ac i i y and dynamome e es
Du ing hes udy,pa ien swillha e hei physicalac i i y mon-
i o ed o 12 mon hs using a Fi bi Cha ge 4 pe sonal moni o
(San F ancisco, CA, USA). Fu he mo e, he o ce o a hand-
shakewillbemoni o edusingaKe nMAP130K1dynamome e .
The dynamome e es measu ing 3×maximum hand p essu e
will be pe o med o bo h dominan and non-dominan uppe
limbs.
Beha io al and die a y counseling
Beha io al and die a y counseling will be p o ided p io
o en ollmen . Nu iP o so wa e (Fi spo -komplex, Czech
Republic) will be used o nu i ional sc eening and e alua ion.
Subjec s will be counseled o ollow a egimen o ou ine
i amin and mine al supplemen a ion. P io o each scheduled
ollow-up, pa icipan s will be e-mailed a pe sonal link o
comple e online ques ionnai es ia Qual ics XM o moni o
hei quali y o li e and physical ac i i y. These a e calib a ed
ques ionnai es SF 36, IWQOL, and he In e na ional Physical
Ac i i yQues ionnai es(IPAQ).Inaddi ion,ques ionnai eswill
be linked o die a y habi s and nu i ional dia y o he las h ee
days.
E hical s a emen
Thes udyhasbeendesignedasap ospec i e andomizeds udy,
which con o ms o he p inciples and guidelines o he Helsinki
Decla a ion, and good clinical p ac ice and has been app o ed
by he E hical Commi ee o he Hospi al AGEL Os a a-
Vi ko ice, Czech Republic (no. EK/243/2020). The clinical ial
egis a ion numbe on Clinical ials.go is NCT04617392.
S a is ical analysis
Powe analysis calcula ion da a a e om he sa copenia pilo
s udy [7]. Es ima ion o he sample size o he e alua ion o
he mean di e ence in pai ed da a was se a a signi icance le el
alpha o 5% and es powe (1-be a) o 90%. Using he mean di -
e ence be ween ALMI and LMI as se pa ame e s, he desi ed
sample size was de e mined o be 22 indi iduals. An icipa ing
a ollow-up loss o up o 20%, we plan o en oll a o al o 40
pa ien s (20 pe g oup). S a a .13.1 o highe (S a aCo p LP,
College S a ion, TX, USA) will be used o conduc he analyses.
The s a is ical signi icance will be se a P<0.05.
Discussion
Sa copenic obesi y is a concu ence o muscle loss and body
a inc ease [14], including educed baseline me abolic a e,
dec eased mi ochond ial numbe and olume, and inc eased
oxida i e s ess [15]. This pa hophysiological sa copenia de el-
opmen can be modula ed by app op ia e physical ac i i y [16].
A s uc u ed exe cise p og am is a easible and e ec i e
adjunc he apy o BMS pa ien s ha esul s in addi ional
ca diome abolic bene i s compa ed o pa ien s expe iencing
weigh loss induced by BMS alone [17]. An addi ional esea ch
opic add essed in he p esen s udy migh include he desc ip-
ion o pa hophysiological mechanisms and answe ing he
ques ion o how and whe he exe cise o physical ac i i y
can o e come he “me abolic adap a ion” o dec eased ene gy
expendi u e ha occu s wi h su ge y-induced weigh loss and
ha e an impac on he o e all daily ene gy balance [18].
Compa ed o o he s udies on in e en ion a e ba ia ic
slee e esec ion, he p esen s udy will be en iched by mul-
idisciplina y da a collec ion. Da a om magne ic esonance,
biomechanical analysis, DXA, dynamome e eadings, nu i-
ional habi analysis, biochemical analysis, moni o ing o phys-
ical ac i i y using ques ionnai es and Fi bi b acele s, and qual-
i y o li e s anda dized ques ionnai es will help o in es iga e
sa copenia in ba ia ic pa ien s.
In all indi iduals, ega dless o he in e en ion, we a e p i-
ma ily expec ing imp o emen s in quali y o li e, changes in
walking pa e ns, imp o emen s in ea ing habi s, and a educ-
ion in o al ene gy in ake and a and muscle mass. In indi idu-
als wi h in e en ion compa ed o hose in he con ol g oup, a
educ ion in he isk o sa copenic obesi y, highe o al p o ein
albumin and p e-albumin le els, lowe le els o as ing glu-
coseandglyca edhemoglobin,main enanceo ahighe physical
ac i i yo e a long pe iod o ime, main enanceand an inc ease
o muscle s eng h, and an inc ease in high-densi y lipop o ein
choles e ol le els a e expec ed.
Radical weigh educ ion has been shown o ha e a posi i e
e ec on he biomechanical pa ame e s o gai , which a e
associa ed wi h a posi i e e ec on knee os eoa h i is [19].
Howe e , changes in bioma ke s Coll2-1 and ibulin-3 ha a e
ela ed okneeca ilageb eakdownha eno beenobse ed[20].
Fu he esea ch will cla i y he ela ionship be ween weigh
loss and knee ca ilage os eoa h i is.
Conclusion
The e is a long-s anding opinion on he e ec o BMS on weigh
loss and he e ec o me abolic in e en ions on diabe es.
Howe e , he isk o muscle loss has no been in es iga ed
despi e he ac ha he p e alence o sa copenic obesi y has
a ai ly signi ican impac on heal h s a us a e su ge y. Recen
da a ha e shown ha he educed muscle issue olume a ec s
wound healing, pa ien mobiliza ion, and glycaemic con ol
a e su ge y. The e a e no cu en ecommenda ions o he
p e en ion o sa copenia, and mo emen is only ecommended
o pa ien s wi hou he need o ollow-up ehabili a ion.
The p oposed s udy should add ess he esea ch ques ions
abou he e ec o p og ammed aining on muscle issue and
an h opome ic unc ions a e BMS, as well as he e ec o
a ge edexe ciseonquali yo li eandconcomi an como bidi y
imp o emen .
Con lic o in e es : The au ho s decla e no con lic s o
in e es .
Funding: This s udy was suppo ed by Speci ic Uni e si y
Resea ch G an no. MUNI/A/1133/2021 and SGS03/PdF/2022
p o ided by he Minis y o Educa ion, You h, and Spo s o he
Czech Republic.
Buˇ
zga e al.
Sa xOb ial p o ocol 196 www.biomolbiomed.com
Submi ed: 1 July 2022
Accep ed: 21 July 2022
Published online: 25 Sep embe 2022
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Rela ed a icles published in BJBMS
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A akan Topcu e al., BJBMS, 2022
Buˇ
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Sa xOb ial p o ocol 197 www.biomolbiomed.com