Background: Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. Thus, in the present study, we aimed at comparing the effect of minimally supervised home-based and closely supervised gym-based exercise programs on weight reduction and insulin resistance after bariatric surgery. Methods: Females undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into 2 groups using a random number generator in Excel. They were either offered a minimally supervised home-based (MSHB) or closely supervised gym-based (CSGB) exercise program. The CSGB protocol constitutes 2 weekly training sessions under ACSM guidelines. In the MSHB protocol, the participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity, and a schedule of follow-up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at baseline and at 20 weeks after the exercises, the results of which were compared using t test or Mann-Whitney U test at the end of the study. All the processes were observed by 1 senior resident in sport medicine. Results: A total of 80 patients were recruited who were all able to complete our study (MSHB= 38 and CSGB= 42). The baseline comparison revealed that the 2 groups were similar. The mean change (reduction) in BMI was slightly better in CSGB (8.61 95% CI 7.76–9.45) compared with the MSHB (5.18 95% CI 3.91–6.46); p< 0.01. However, the 2 groups did not have a statistically significant difference in the amount of change in the other factors including FBS and Homa.ir. Conclusion: As we expected a non-inferiority result, our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improving lipid profile and insulin resistance in the 2 groups, but a slightly better effect on BMI was observed in CSGB group. With considerably lower costs of minimally supervised home- based exercise programs, both methods should be considered when there is lack of adequate funding.
Leiomyosarcoma is an aggressive type of soft tissue neoplasm that originates from smooth muscle cells; it is typically found in the uterus, gastrointestinal tract, and retroperitoneum. Primary leiomyosarcoma of bone is an extremely rare phenomenon first reported in 1965. Here, we present a case of primary leiomyosarcoma of bone occurred in the proximal humerus of a 41-year-old man who was referred to our orthopaedic clinic with a chief complaint of persistent left shoulder pain. Radiological investigations revealed a proximal lesion of the left humerus with periosteal reaction. Core needle biopsy of the lesion was performed later, which pointed to primary leiomyosarcoma of bone as the underlying pathology. Subsequently, complete resection of the lesion and prosthetic replacement of the proximal humorous were performed. The patient was followed three months after the surgery, and no sign of local recurrence or metastatic lesion was detected. To the best of our knowledge, this is the first case report of primary leiomyosarcoma of bone in Iran.
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