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Bourgonje AR, Knobbe TJ, Kremer D, Bulthuis MLC, Bemelman FJ, Berger SP, Navis GJ, Bakker SJL, Corpeleijn E, van Goor H. Effect of lifestyle intervention on systemic oxidative stress in kidney transplant recipients: A post-hoc analysis of the Active Care after Transplantation (ACT) randomized controlled trial. Free Radic Biol Med 2025; 232:412-420. [PMID: 40043960 DOI: 10.1016/j.freeradbiomed.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/27/2025] [Accepted: 03/02/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Oxidative stress is associated with adverse outcomes in kidney transplant recipients (KTR), including graft failure, morbidity, and mortality. Since both exercise training and dietary modifications have the potential to improve redox status, we aimed to investigate the potential mitigating effects of exercise or exercise plus diet intervention on circulating levels of free thiols (R-SH) as marker of systemic redox status in KTR. METHODS We conducted a post-hoc analysis of the Active Care after Transplantation (ACT) study, a randomized controlled lifestyle intervention trial which proved to enhance physical functioning of KTR. Systemic R-SH levels were quantified at baseline, 3-months, and 15-months (end of study) using a colorimetric detection method. Estimated marginal means (EMM) were reported using general linear mixed models. RESULTS KTR were randomized to usual care (n = 40), exercise intervention (n = 54), or exercise plus diet intervention (n = 55). At 3 months post-baseline, systemic R-SH concentrations decreased significantly in the control group, while the intervention groups showed a less pronounced decrease, although the difference compared to control nearly reached statistical significance in either the exercise intervention group (EMM +20.2 μM (95%CI -1.4, +41.9), P = 0.067) or the exercise plus diet intervention group (EMM +18.9 μM (95%CI -2.7, +40.4), P = 0.086). At 15 months post-baseline, R-SH concentrations further decreased in the exercise intervention group, resulting in a difference compared to control of +9.0 μM (95%CI -14.4, +32.3; P = 0.45), whereas R-SH concentrations increased to above baseline in the exercise plus diet intervention group, with a statistically significant difference compared to control of +32.8 μM (95%CI +9.4, +56.2; P = 0.006). CONCLUSIONS Lifestyle changes involving exercise and diet positively impacted systemic R-SH, suggesting that reducing oxidative stress through lifestyle interventions could potentially contribute to clinical benefits in KTR.
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Affiliation(s)
- Arno R Bourgonje
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, the Netherlands; The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tim J Knobbe
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, the Netherlands
| | - Daan Kremer
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, the Netherlands
| | - Marian L C Bulthuis
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Division of Nephrology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stefan P Berger
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, the Netherlands
| | - Gerjan J Navis
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, the Netherlands
| | - Stephan J L Bakker
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, the Netherlands
| | - Eva Corpeleijn
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Harry van Goor
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands.
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Tozo JVA, Tadiotto MC, Tozo TAA, de Menezes-Junior FJ, Mota J, de Pereira BO, Rosário R, Leite N. Effects of different physical exercise programs on blood pressure in overweight children and adolescents: systematic review and meta-analysis. BMC Pediatr 2025; 25:252. [PMID: 40155857 PMCID: PMC11951679 DOI: 10.1186/s12887-025-05575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 03/06/2025] [Indexed: 04/01/2025] Open
Abstract
AIMS The purpose of this meta-analysis was to systematically review studies in the literature that evaluated the effect of different exercise programs on blood pressure in overweight children and adolescents. DATA SOURCES In September 2024, studies were searched in six electronic databases (PubMed, Web of Science, Scopus, Sportdiscus, Lilacs, and Scielo) and in reference lists. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Randomized and non-randomized controlled trials with interventions involving physical exercise programs and assessment of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children and adolescents with overweight and/or obesity were considered for synthesis. STUDY APPRAISAL AND SYNTHESIS METHODS The quality of studies was assessed using the PEDro scale for studies with randomized clinical trials. Meta-analysis was conducted using a random model in the Review Manager Software. RESULTS Seventeen studies were selected that involved 1,125 children and adolescents. The risk of bias score was considered moderate (five to eight points out of 11). The high-intensity interval training (HIIT) showed the largest effect, indicating a greater impact on BP reduction, while moderate-intensity continuous training (MICT) also had a significant effect, although with greater heterogeneity. No significant effects were found for the other types of exercise. For SBP, a summary effect of -0.44 (95% CI=-0.68; -0.20; I2 = 73%) was observed. For DBP, the metanalysis indicated - 0.52 (95% CI=-0.73; -0.31; I2 = 63%). LIMITATIONS There was a publication time limitation of ten years, and the search was restricted to articles published in journals indexed in databases, and there was also significant heterogeneity for the intervention subgroups, which can be explained by the moderate methodological quality of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Considering the significant effects of exercise interventions on blood pressure, we suggest the development of more interventions based on physical exercise practice for overweight and obese children and adolescents, which may also add environmental elements, lasting at least 12 weeks, with three 60-minute sessions per week, better control of exercise intensity, as HIIT and MICT were more effective in promoting a reduction in blood pressure when compared to other types of exercise. The implementation of these programs must be carried out in a multicomponent and multiprofessional approach to guarantee the adherence of participants and promote significant and sustainable changes in the cardiovascular health of children and adolescents. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO no CRD42023469222.
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Affiliation(s)
- João Victor Affornali Tozo
- Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Brazil
- Quality of Life Center (NQV), Federal University of Paraná, Curitiba, Brazil
| | - Maiara Cristina Tadiotto
- Quality of Life Center (NQV), Federal University of Paraná, Curitiba, Brazil.
- Physical Education Department, Federal University of Parana, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, 81531- 980, Paraná, Brazil.
| | - Tatiana A Affornali Tozo
- Quality of Life Center (NQV), Federal University of Paraná, Curitiba, Brazil
- Research Centre on Child Studies (CIEC), University of Minho, Braga, Portugal
| | | | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto, Porto, Portugal
| | | | - Rafaela Rosário
- Health Sciences Research Unit: Nursing (UICISA:E), University of Minho, Braga, Portugal
| | - Neiva Leite
- Quality of Life Center (NQV), Federal University of Paraná, Curitiba, Brazil
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto, Porto, Portugal
- Physical Education Department, Federal University of Parana, Street Col. Francisco H. dos Santos, 100, Jardim das Americas, Curitiba, 81531- 980, Paraná, Brazil
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Baffour-Awuah B, Man M, Goessler KF, Cornelissen VA, Dieberg G, Smart NA, Pearson MJ. Effect of exercise training on the renin-angiotensin-aldosterone system: a meta-analysis. J Hum Hypertens 2024; 38:89-101. [PMID: 38017087 PMCID: PMC10844078 DOI: 10.1038/s41371-023-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 11/30/2023]
Abstract
Blood pressure (BP) management reduces the risk of cardiovascular disease (CVD). The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating and maintaining blood volume and pressure. This analysis aimed to investigate the effect of exercise training on plasma renin, angiotensin-II and aldosterone, epinephrine, norepinephrine, urinary sodium and potassium, BP and heart rate (HR). We systematically searched PubMed, Web of Science, and the Cochrane Library of Controlled Trials until 30 November 2022. The search strategy included RAAS key words in combination with exercise training terms and medical subject headings. Manual searching of reference lists from systematic reviews and eligible studies completed the search. A random effects meta-analysis model was used. Eighteen trials with a total of 803 participants were included. After exercise training, plasma angiotensin-II (SMD -0.71; 95% CI -1.24, -0.19; p = 0.008; n = 9 trials), aldosterone (SMD -0.37; 95% CI -0.65, -0.09; p = 0.009; n = 8 trials) and norepinephrine (SMD -0.82; 95% CI -1.18, -0.46; p < 0.001; n = 8 trials) were reduced. However, plasma renin activity, epinephrine, and 24-h urinary sodium and potassium excretion remained unchanged with exercise training. Systolic BP was reduced (MD -6.2 mmHg; 95% CI -9.9, -2.6; p = 0.001) as was diastolic BP (MD -4.5 mmHg; 95% CI -6.9, -2.1; p < 0.001) but not HR (MD -3.0 bpm; 95% CI -6.0, 0.4; p = 0.053). Exercise training may reduce some aspects of RAAS and sympathetic nervous system activity, and this explains some of the anti-hypertensive response.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Melody Man
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Karla F Goessler
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Véronique A Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gudrun Dieberg
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia.
| | - Neil A Smart
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Melissa J Pearson
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
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Belkin TG, Tham YK, McMullen JR. Lipids regulated by exercise and PI3K: potential role as biomarkers and therapeutic targets for cardiovascular disease. CURRENT OPINION IN PHYSIOLOGY 2023. [DOI: 10.1016/j.cophys.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Ischemic heart disease and stroke are the number 1 and number 2 causes of death worldwide, respectively. A lifelong commitment to exercise reduces the risk of these adverse events and is also associated with several cardiometabolic improvements, including reductions in blood pressure, cholesterol, and inflammatory markers, as well as improved glucose control. Routine exercise also reduces the risk of developing comorbidities that increase the risk of cardiovascular or cerebrovascular disease. While the benefits of a lifelong commitment to exercise are well documented, there is a complex interaction between exercise and stroke risk, such that the risk of ischemic or hemorrhagic stroke may increase acutely during or immediately following exercise. In this article, we discuss the physiological responses to different types of exercise, as well as the determinants of resting and exertional cerebrovascular perfusion, and explore the complex interaction between atrial fibrillation, exercise, and stroke risk. Finally, we highlight the increased risk of stroke during different types of exercise, as well as factors that may alleviate this risk.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora. (J.A.E., W.K.C.)
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora. (J.A.E., W.K.C.).,Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora. (W.K.C.)
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Calogero A, Sagnelli C, Peluso G, Sica A, Candida M, Campanile S, Minieri G, Incollingo P, Creta M, Pelosio L, Tammaro V, Scotti A, Jamshidi A, Caggiano M, Sagnelli E, Dodaro CA, Carlomagno N, Santangelo M. Physical activity in elderly kidney transplant patients with multiple renal arteries. Minerva Med 2022; 113:119-127. [PMID: 32338484 DOI: 10.23736/s0026-4806.20.06573-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the gold standard for treatment of patients with end-stage-renal disease. To expand the donor reserve, it is necessary to use marginal/suboptimal kidneys. METHODS We retrospectively evaluated the short/long-term outcome of 34 KT elderly patients who received allografts with vascular abnormalities (MRA group), in comparison with 34 KT patients who received a kidney with a single renal artery (SRA group) pair-matched by age, length of time on dialysis, comorbidity and donor age. RESULTS All participants completed the International Physical Activity Questionnaire at KT, and then 4, 8, and 12 weeks after transplantation. Our data indicate that kidney with vascular anatomical variants may be successfully transplanted, since the overall rate of surgical complications was 20.6% in the SRA group and 17.6% in the MRA group and that the 5-year survival rate after KT was 100% in both groups. CONCLUSIONS The data also underlined that individualized physical activity programs induced similar excellent results in both groups, improving physical capacities, arterial pressure, lipid metabolism, insulin sensitivity, quality of life and physical and mental status.
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Affiliation(s)
- Armando Calogero
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, Federico II University, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Gaia Peluso
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Maria Candida
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Silvia Campanile
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gianluca Minieri
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Incollingo
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Massimiliano Creta
- Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, Federico II University, Naples, Italy
| | - Luigi Pelosio
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Vincenzo Tammaro
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessandro Scotti
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Akbar Jamshidi
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marcello Caggiano
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Evangelista Sagnelli
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Concetta A Dodaro
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, Federico II University, Naples, Italy
| | - Nicola Carlomagno
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Michele Santangelo
- Unit of General Surgery and Transplant, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, Federico II University, Naples, Italy
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Lin Y, Zhang B, Hu M, Xu M, Qin C, Zhu C. [Causal relationship between physical exercise and risk of ischemic stroke recurrence based on the potential outcome theory]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1191-1197. [PMID: 34549710 DOI: 10.12122/j.issn.1673-4254.2021.08.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the causal relationship between physical exercise and ischemic stroke recurrence using a multiple imputation approach based on the potential outcomes framework. METHODS We collected data from 636 patients who were diagnosed with first-ever ischemic stroke between July, 2010 and December, 2018 at West China Hospital, Sichuan University.All the patients had motor ability and were followed up at least for 1 year.According to the intensity of physical exercise, the patients were divided into low-level physical exercise (LPE) group (n=244) and moderate-to high-intensity exercise (MHPE) group (n=392).With both the result and the time of recurrence as the potential outcomes, a multiple imputation method was used to impute the missing values based on a predictive matrix.Based on the imputed datasets, a causal inference model was built to estimate the average causal effect of physical exercise on the risk of stroke recurrence. RESULTS Among the enrolled patients, 148 experienced recurrent stroke with a median recurrence time of 24.0 months and a cumulative recurrence rate of 23.3%during follow-up.As there were no outliers and the marginal distributions of the potential outcomes were basically consistent, both the Strip plots and Kenel density plots indicated that the imputed values could have been plausible measurements if they had not been missing.The average causal effect (ACE) of physical exercise on stroke recurrence was 0.578 (95%CI: 0.186-0.970, P=0.012). CONCLUSION There is a causal relationship between physical exercise and the risk of ischemic stroke recurrence, indicating the value of moderate or high-level exercise after stroke in reducing the risk of stroke recurrence.
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Affiliation(s)
- Y Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - B Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - M Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - M Xu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C Qin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Neurologic complications of cardiac disease in athletes. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:269-274. [PMID: 33632446 DOI: 10.1016/b978-0-12-819814-8.00031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Athletic participation at all levels of proficiency is an encouraged activity. Physicians evaluating athletes are tasked with assessing the benefits and risks of participating in vigorous physical activity and should engage in shared decision making with the athlete. Identifying the neurologic sequelae is an essential part of the assessment that is often not covered. This chapter will review the association of a wide range of cardiac disorders that can be related to or associated with subsequent neurologic sequelae, along with a brief overview of recommendations for management. Prevalent neurological complications of cardiac disease in athletes include stroke and seizures. There are also certain channelopathies that result in concurrent cardiac dysrhythmias and epilepsy. In addition, physiologic cardiac rhythm changes and the athlete's heart are discussed in the context of the differential diagnoses of subsequent cardiac and neurologic disease. The primary objective of this chapter is to prepare the physician for accurate recognition of cardiac disease in athletes that could result in neurologic complications if not diagnosed and managed early on.
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Calella P, Hernández-Sánchez S, Garofalo C, Ruiz JR, Carrero JJ, Bellizzi V. Exercise training in kidney transplant recipients: a systematic review. J Nephrol 2019; 32:567-579. [DOI: 10.1007/s40620-019-00583-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 01/04/2019] [Indexed: 12/20/2022]
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Bernardo BC, Ooi JYY, Weeks KL, Patterson NL, McMullen JR. Understanding Key Mechanisms of Exercise-Induced Cardiac Protection to Mitigate Disease: Current Knowledge and Emerging Concepts. Physiol Rev 2018; 98:419-475. [PMID: 29351515 DOI: 10.1152/physrev.00043.2016] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The benefits of exercise on the heart are well recognized, and clinical studies have demonstrated that exercise is an intervention that can improve cardiac function in heart failure patients. This has led to significant research into understanding the key mechanisms responsible for exercise-induced cardiac protection. Here, we summarize molecular mechanisms that regulate exercise-induced cardiac myocyte growth and proliferation. We discuss in detail the effects of exercise on other cardiac cells, organelles, and systems that have received less or little attention and require further investigation. This includes cardiac excitation and contraction, mitochondrial adaptations, cellular stress responses to promote survival (heat shock response, ubiquitin-proteasome system, autophagy-lysosomal system, endoplasmic reticulum unfolded protein response, DNA damage response), extracellular matrix, inflammatory response, and organ-to-organ crosstalk. We summarize therapeutic strategies targeting known regulators of exercise-induced protection and the challenges translating findings from bench to bedside. We conclude that technological advancements that allow for in-depth profiling of the genome, transcriptome, proteome and metabolome, combined with animal and human studies, provide new opportunities for comprehensively defining the signaling and regulatory aspects of cell/organelle functions that underpin the protective properties of exercise. This is likely to lead to the identification of novel biomarkers and therapeutic targets for heart disease.
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Affiliation(s)
- Bianca C Bernardo
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Jenny Y Y Ooi
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Kate L Weeks
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Natalie L Patterson
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
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Yerrakalva D, Cooper AJ, Westgate K, Khaw KT, Wareham NJ, Brage S, Griffin SJ, Wijndaele K. The descriptive epidemiology of the diurnal profile of bouts and breaks in sedentary time in older English adults. Int J Epidemiol 2018; 46:1871-1881. [PMID: 29025094 DOI: 10.1093/ije/dyx123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background High sedentary time is associated with adverse metabolic health outcomes and mortality in older adults. It has been suggested that breaking up sedentary time may be beneficial for metabolic health; however, population prevalence data are lacking on the patterns of sedentary behaviour which would identify opportunities for intervention. Methods We used data of adults aged ≥ 60 years (n = 3705) from the population-based EPIC-Norfolk cohort, to characterize the patterns of total sedentary time, breaks in sedentary time and sedentary bouts across the day and assess their associations with participant characteristics, using multi-level regression. Sedentary time was measured objectively by a hip-mounted accelerometer (ActigraphTM GT1M) worn for 7 days during waking time. Results More than 50% of every waking hour was spent sedentary, increasing to a peak of 83% in the evening. On average fewer breaks were accrued in the evenings compared with earlier in the day. Marginally more sedentary time was accrued on weekend days compared with weekdays (difference 7.4 min, 95% confidence interval 5.0-9.7). Large proportions of this sedentary time appear to be accrued in short bouts (bouts of < 10 min for 32% of the time). Older age, being male, being retired, not being in paid employment and having a higher body mass index were associated with greater sedentary time and fewer breaks. Conclusion Sedentary time is common throughout the day but peaks in the evenings with fewer breaks and longer bouts. We identified a number of characteristics associated with sedentary time and additionally inversely associated with sedentary breaks, which should inform the development and targeting of strategies to reduce sedentary time among older adults.
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Affiliation(s)
| | - A J Cooper
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - K Westgate
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - K T Khaw
- Department of Public Health and Primary Care
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S J Griffin
- Department of Public Health and Primary Care.,MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - K Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Roberson KB, Potiaumpai M, Widdowson K, Jaghab AM, Chowdhari S, Armitage C, Seeley A, Jacobs KA, Signorile JF. Effects of high-velocity circuit resistance and treadmill training on cardiometabolic risk, blood markers, and quality of life in older adults. Appl Physiol Nutr Metab 2018. [DOI: 10.1139/apnm-2017-0807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disease (CVD) and mortality and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied, no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 females, 8 males) were randomly assigned to 1 of 3 groups: HVCRT, TM, or control. Participants in the exercise groups attended training 3 days/week for a total of 12 weeks. Of the 30 participants who began the study, 24 (19 females, 5 males) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL. All variables were measured pre- and post-intervention. CMS z score significantly decreased for HVCRT (p = 0.03), while there were no significant changes for TM or control. FRS significantly decreased for HVCRT compared with TM (p = 0.03) and control (p = 0.03). Significant decreases in systolic (p < 0.01) and diastolic blood pressures (p < 0.01) for HVCRT accompanied significant increases from baseline in stroke volume (p = 0.03) and end-diastolic volume (p < 0.01). Systemic vascular resistance significantly decreased (p = 0.05) for HVCRT compared with control. Emotional well-being significantly improved following HVCRT and TM compared with control (p = 0.04; p = 0.03). HVCRT represents a novel training modality that improved factors in each of the 3 components assessed.
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Affiliation(s)
- Kirk B. Roberson
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Melanie Potiaumpai
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Kayla Widdowson
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Ann-Marie Jaghab
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Sean Chowdhari
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Catherine Armitage
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Afton Seeley
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Kevin A. Jacobs
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
| | - Joseph F. Signorile
- Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33124, USA
- Center on Aging, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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14
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Fiogbé E, Ferreira R, Sindorf MAG, Tavares SA, de Souza KP, de Castro Cesar M, Lopes CR, Moreno MA. Water exercise in coronary artery disease patients, effects on heart rate variability, and body composition: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [PMID: 29542251 DOI: 10.1002/pri.1713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE It is important to assess the effectiveness and efficiency of water-based training programs in order to prescribe it as an alternative in cardiac rehabilitation for patients who have coronary artery disease (CAD). In these patients, autonomic dysfunction is an important physiological change strongly associated with adverse outcomes, morbidity, and mortality. Given that the beneficial effects of physical training in CAD patients have been traditionally evidenced with programs involving land-based aerobic exercises, this study aims to evaluate the effects of water aerobic exercise training (WAET) on the autonomic modulation of heart rate (HR) and body composition, in the rehabilitation of CAD patients. METHODS Twenty-six male subjects with CAD were randomly divided into a training group (n = 14), submitted to the WAET, and a control group (n = 12). The WAET consisted of 3 weekly sessions on alternate days, totalling 48 sessions. The analysis of HR variability was used to evaluate the autonomic modulation of HR, from the recording of R-R intervals for 15 min, at rest in the supine position, and the body composition was evaluated through the bioelectrical impedance analysis. RESULTS Only the training group participants had improvement in the HR variability indices; patterns without variation decreased (0V, p = .005) and an increase of patterns of two different variations (p < .001), Shannon entropy (p = .02), and normalized conditional entropy (p = .03), whereas the control group had an increase of 0V (p = .04) and a decrease of normalized conditional entropy (p = .01). All body composition variables remained unchanged. CONCLUSIONS The WAET protocol improved the cardiac autonomic modulation of patients with CAD and can be considered as exercise training strategy in cardiac rehabilitation programs.
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Affiliation(s)
- Elie Fiogbé
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil.,Post-Graduation Program in Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Rafaela Ferreira
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Márcio Antônio Gonçalves Sindorf
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Silvia Aparecida Tavares
- Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Keiti Passoni de Souza
- Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Marcelo de Castro Cesar
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
| | - Charles Ricardo Lopes
- Post-Graduation Program in Physical Education, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil.,Faculty Adventist of Hortolândia (UNASP), Hortolândia, SP, Brazil
| | - Marlene Aparecida Moreno
- Post-Graduation Program in Physical Therapy, College of Health Sciences, Methodist University of Piracicaba (UNIMEP), Piracicaba, SP, Brazil
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15
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DeLucia CM, De Asis RM, Bailey EF. Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women. Exp Physiol 2018; 103:201-211. [PMID: 29178489 DOI: 10.1113/ep086641] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/14/2023]
Abstract
NEW FINDINGS What is the central question of this study? What impact does inspiratory muscle training have on systemic vascular resistance, cardiac output and baroreflex sensitivity in adult men and women? What is the main finding and its importance? Inspiratory muscle training exerts favorable effects on blood pressure, vascular resistance and perception of stress. This exercise format is well-tolerated and equally effective whether implemented in men or women. ABSTRACT Previous work has shown that inspiratory muscle training (IMT) lowers blood pressure after a mere 6 weeks, identifying IMT as a potential therapeutic intervention to prevent or treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximal inspiratory pressure) groups and underwent a 6-week intervention comprising 30 breaths day-1 , 5 days week-1 . Pre- and post-training measures included maximal inspiratory pressure and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen-Hoberman inventory of physical symptoms and the Epworth sleepiness scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (-4.3/-3.9 mmHg, P < 0.025) and systemic vascular resistance (-3.5 mmHg min l-1 , P = 0.008) at week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795) or spontaneous cardiac baroreflex sensitivity (P = 0.776). The IMT subjects also reported fewer stress-related symptoms (pre- versus post-training, 12.5 ± 8.5 versus 7.2 ± 9.7, P = 0.025). Based on these results, we suggest that a short course of IMT confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.
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Affiliation(s)
- Claire M DeLucia
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Roxanne M De Asis
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - E Fiona Bailey
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
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16
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Pollak A, Merin G, Horowitz M, Shochina M, Gilon D, Hasin Y. Heat Acclimatization Protects the Left Ventricle from Increased Diastolic Chamber Stiffness Immediately after Coronary Artery Bypass Surgery: A Lesson from 30 Years of Studies on Heat Acclimation Mediated Cross Tolerance. Front Physiol 2017; 8:1022. [PMID: 29311958 PMCID: PMC5732210 DOI: 10.3389/fphys.2017.01022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/27/2017] [Indexed: 12/27/2022] Open
Abstract
During the period of 1986–1997 the first 4 publications on the mechanical and metabolic properties of heat acclimated rat's heart were published. The outcome of these studies implied that heat acclimation, sedentary as well as combined with exercise training, confers long lasting protection against ischemic/reperfusion insult. These results promoted a clinical study on patients with coronary artery disease scheduled for elective coronary artery bypass operations aiming to elucidate whether exploitation of environmental stress can be translated into human benefits by improving physiological recovery. During the 1998 study, immediate-post operative chamber stiffness was assessed in patients acclimatized to heat and low intensity training in the desert (spring in the Dead Sea, 17–33°C) vs. patients in colder weather (spring in non-desert areas, 6–19°C) via echocardiogram acquisition simultaneous with left atrial pressure measurement during fast intravascular fluid bolus administration. We showed that patients undergoing “heat acclimatization combined with exercise training” were less susceptible to ischemic injury, therefore expressing less diastolic dysfunction after cardiopulmonary bypass compared to non-acclimatized patients. This was the first clinical translational study on cardiac patients, while exploiting environmental harsh conditions for human benefits. The original experimental data are described and discussed in view of the past as well as the present knowledge of the protective mechanisms induced by Heat Acclimation Mediated Cross-tolerance.
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Affiliation(s)
- Arthur Pollak
- Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gideon Merin
- Department of Cardio-Thoracic Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Horowitz
- Laboratory of Environmental Physiology, Faculty of Dentistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mara Shochina
- Department of Rehabilitation, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Gilon
- Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonathan Hasin
- Department of Cardiology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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17
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Howden EJ, Lawley JS, Esler M, Levine BD. Potential role of endurance training in altering renal sympathetic nerve activity in CKD? Auton Neurosci 2016; 204:74-80. [PMID: 27908698 DOI: 10.1016/j.autneu.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease (CKD), is characterized by a progressive loss of renal function and increase in cardiovascular risk. In this review paper, we discuss the pathophysiology of increased sympathetic nerve activity in CKD patients and raise the possibility of endurance exercise being an effective countermeasure to address this problem. We specifically focus on the potential role of endurance training in altering renal sympathetic nerve activity as increased renal sympathetic nerve activity negatively impacts kidney function as well indirectly effects multiple other systems and organs. Recent technological advances in device based therapy have highlighted the detrimental effect of elevated renal sympathetic nerve activity in CKD patients, with kidney function and blood pressure being improved post renal artery nerve denervation in selected patients. These developments provide optimism for the development of alternative and/or complementary strategies to lower renal sympathetic nerve activity. However, appropriately designed studies are required to confirm preliminary observations, as the widespread use of the renal denervation approach to lower sympathetic activity presently has limited feasibility. Endurance training may be one alternative strategy to reduce renal sympathetic nerve activity. Here we review the role of endurance training as a potential alternative or adjunctive to current therapy in CKD patients. We also provide recommendations for future research to assist in establishing an evidence base for the use of endurance training to lower renal sympathetic activity in CKD patients.
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Affiliation(s)
- Erin J Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States; Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States
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18
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Straznicky NE, Grima MT, Sari CI, Lambert EA, Phillips SE, Eikelis N, Mariani JA, Kobayashi D, Hering D, Dixon JB, Lambert GW. Comparable Attenuation of Sympathetic Nervous System Activity in Obese Subjects with Normal Glucose Tolerance, Impaired Glucose Tolerance, and Treatment Naïve Type 2 Diabetes following Equivalent Weight Loss. Front Physiol 2016; 7:516. [PMID: 27857694 PMCID: PMC5093133 DOI: 10.3389/fphys.2016.00516] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Elevated sympathetic nervous system (SNS) activity is a characteristic of obesity and type 2 diabetes (T2D) that contributes to target organ damage and cardiovascular risk. In this study we examined whether baseline metabolic status influences the degree of sympathoinhibition attained following equivalent dietary weight loss. Methods: Un-medicated obese individuals categorized as normal glucose tolerant (NGT, n = 15), impaired glucose tolerant (IGT, n = 24), and newly-diagnosed T2D (n = 15) consumed a hypocaloric diet (29% fat, 23% protein, 45% carbohydrate) for 4-months. The three groups were matched for baseline age (56 ± 1 years), body mass index (BMI, 32.9 ± 0.7 kg/m2), and gender. Clinical measurements included whole-body norepinephrine kinetics, muscle sympathetic nerve activity (MSNA, by microneurography), spontaneous cardiac baroreflex sensitivity (BRS), and oral glucose tolerance test. Results: Weight loss averaged −7.5 ± 0.8, −8.1 ± 0.5, and −8.0 ± 0.9% of body weight in NGT, IGT, and T2D groups, respectively. T2D subjects had significantly greater reductions in fasting glucose, 2-h glucose and glucose area under the curve (AUC0−120) compared to NGT and IGT (group effect, P <0.001). Insulinogenic index decreased in IGT and NGT groups and increased in T2D (group × time, P = 0.04). The magnitude of reduction in MSNA (−7 ± 3, −8 ± 4, −15 ± 4 burst/100 hb, respectively) and whole-body norepinephrine spillover rate (−28 ± 8, −18 ± 6, and −25 ± 7%, respectively), time effect both P <0.001, did not differ between groups. After adjustment for age and change in body weight, Δ insulin AUC0−120 was independently associated with reduction in arterial norepinephrine concentration, whilst Δ LDL-cholesterol and improvement in BRS were independently associated with decrease in MSNA. Conclusions: Equivalent weight loss through hypocaloric diet is accompanied by similar sympathoinhibition in matched obese subjects with different baseline glucose tolerance. Attenuation of hyperinsulinemia and hyperlipidemia, rather than glycemic indices, is associated with reduction in SNS activity following weight loss intervention.
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Affiliation(s)
- Nora E Straznicky
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Mariee T Grima
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Carolina I Sari
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Elisabeth A Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes InstituteMelbourne, VIC, Australia; Department of Physiology, Monash UniversityMelbourne, VIC, Australia; Department of Physiology, University of MelbourneMelbourne, VIC, Australia
| | - Sarah E Phillips
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Nina Eikelis
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Justin A Mariani
- Heart Failure Research Group, Baker IDI Heart and Diabetes InstituteMelbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash UniversityMelbourne, VIC, Australia
| | - Daisuke Kobayashi
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - Dagmara Hering
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute Melbourne, VIC, Australia
| | - John B Dixon
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes InstituteMelbourne, VIC, Australia; Department of Primary Health Care, Monash UniversityMelbourne, VIC, Australia
| | - Gavin W Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes InstituteMelbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash UniversityMelbourne, VIC, Australia
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Frequent interruptions of sedentary time modulates contraction- and insulin-stimulated glucose uptake pathways in muscle: Ancillary analysis from randomized clinical trials. Sci Rep 2016; 6:32044. [PMID: 27554943 PMCID: PMC4995429 DOI: 10.1038/srep32044] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/27/2016] [Indexed: 01/28/2023] Open
Abstract
Epidemiological studies have observed associations between frequent interruptions of sitting time with physical activity bouts and beneficial metabolic outcomes, even in individuals who regularly exercise. Frequent interruptions to prolonged sitting reduce postprandial plasma glucose. Here we studied potential skeletal muscle mechanisms accounting for this improved control of glycemia in overweight adults under conditions of one day uninterrupted sitting and sitting interrupted with light-intensity or moderate-intensity walking every 20-min (n = 8); and, after three days of either uninterrupted sitting or light-intensity walking interruptions (n = 5). Contraction- and insulin-mediated glucose uptake signaling pathways as well as changes in oxidative phosphorylation proteins were examined. We showed that 1) both interventions reduce postprandial glucose concentration, 2) acute interruptions to sitting over one day stimulate the contraction-mediated glucose uptake pathway, 3) both acute interruptions to sitting with moderate-intensity activity over one day and light-intensity activity over three days induce a transition to modulation of the insulin-signaling pathway, in association with increased capacity for glucose transport. Only the moderate-intensity interruptions resulted in greater capacity for glycogen synthesis and likely for ATP production. These observations contribute to a mechanistic explanation of improved postprandial glucose metabolism with regular interruptions to sitting time, a promising preventive strategy for metabolic diseases.
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20
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Abstract
Aerobic exercise may prevent hypertension and reduce blood pressure and mortality in hypertensive patients and those at high risk for coronary artery disease. Supervised aerobic exercise at an intensity of 70% to 80% of maximal aerobic capacity is recommended to achieve cardiovascular conditioning and other health benefits. When antihypertensive drug therapy is required, physicians should choose an agent that has favorable secondary effects, including hemodynamic responses to exercise. The most favorable effects are achieved with calcium channel blockers, angiotensin-converting enzyme inhibitors, alpha blockers, and central alpha agonists. The effects of diuretics are less desirable, and beta blockers should be a last choice for hypertensive patients who are physically active.
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Affiliation(s)
- M C Houston
- Vanderbilt University School of Medicine, Nashville, Tennessee
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21
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Abstract
OBJECTIVE The aim of this study was to assess whether a former career as an elite athlete protects from hypertension in later life. We hypothesized that vigorous physical activity during young adulthood protects against hypertension later in life. METHODS The study population (n = 3440) consists of 2037 former male elite athletes and 1403 matched controls. Of those, 599 (392 former athletes, 207 controls) participated in a clinical study in 2008. The athletes were divided into three groups: endurance, mixed and power sports. Assessment of hypertension was based on athletes' entitlement to reimbursable antihypertensive medication from the Finnish Social Insurance Institution; among the clinical study participants, this was also based on self-reported current use of antihypertensive drugs or measured hypertension. The current volume of leisure-time physical activity (LTPA) was determined by questionnaires. RESULTS Among the participants, the former athletes had lower age-adjusted prevalence of hypertension than the controls [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49-0.98] and the endurance athletes had the lowest OR (OR 0.43, 95% CI 0.23-0.80). OR for the prevalence of hypertension decreased (OR 0.90, 95% CI 0.84-0.96 per 10 metabolic equivalent hours/week) when there was an increase in the volume of LTPA. The former athletes without blood pressure-lowering medication had significantly lower SBP than the controls [139.2 mmHg (SD 18.7) vs. 144.2 mmHg (SD 19.5)] (P = 0.027). CONCLUSION A former career as an elite athlete seems to be associated with a lower prevalence of hypertension in later life. The volume of current LTPA was inversely related to prevalence of hypertension.
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Zelle DM, Corpeleijn E, Klaassen G, Schutte E, Navis G, Bakker SJL. Fear of Movement and Low Self-Efficacy Are Important Barriers in Physical Activity after Renal Transplantation. PLoS One 2016; 11:e0147609. [PMID: 26844883 PMCID: PMC4742485 DOI: 10.1371/journal.pone.0147609] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity (PA) and exercise are commonly used as preventive measures for cardiovascular disease in the general population, and could be effective in the management of post-transplantation cardiovascular risk. PA levels are low after renal transplantation and very few renal transplant recipients (RTR) meet the PA guidelines. Identification of barriers to regular PA is important to identify targets for intervention to improve PA levels after renal transplantation. We investigated fear of movement and physical self-efficacy as barriers to PA in RTR. METHODS RTR were investigated between 2001-2003. The Tampa Score of Kinesiophobia-Dutch Version (TSK-11) was used to assess fear of movement. Physical self-efficacy was measured with the LIVAS-scale. PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). RESULTS A total of 487 RTR (age 51±12 years, 55% men) were studied. Median score [interquartile range] on TSK-11 was 22 [17-26]. Low physical self-efficacy (Exp B:0.41[0.31-0.54], p<0.001) and history of myocardial infarction, transient ischemic attack and cerebrovascular accident (Exp B:1.30[1.03-1.63],p = 0.03) were independent determinants for fear of movement. Fear of movement was associated with lower daily PA, occupational, sports and leisure time PA. Mediation-analysis showed that a large part (73%) of the effect of fear of movement on PA was explained by low physical self-efficacy. CONCLUSIONS This study was the first to examine fear of movement and self-efficacy in relation to PA in RTR. Fear of movement was associated with a low PA level, and the larger part of this relation was mediated by low physical self-efficacy. Both fear of movement and physical self-efficacy level are important targets for intervention during rehabilitation after renal transplantation.
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Affiliation(s)
- Dorien M. Zelle
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerald Klaassen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise Schutte
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Effect of exercise training on the renin-angiotensin-aldosterone system in healthy individuals: a systematic review and meta-analysis. Hypertens Res 2015; 39:119-26. [PMID: 26399454 DOI: 10.1038/hr.2015.100] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023]
Abstract
The aim of this systematic review and meta-analysis was to evaluate the effect of exercise training on parameters of the renin-angiotensin-aldosterone system (RAAS) in healthy adults, and to investigate the relation with training induced changes in blood pressure. A systematic search was conducted and we included randomized controlled trials lasting ⩾4 weeks investigating the effects of exercise on parameters of the RAAS in healthy adults (age ⩾18 years) and published in a peer-reviewed journal up to December 2013. Fixed effects models were used and data are reported as weighted means and 95% confidence limits (CL). Eleven randomized controlled trials with a total of 375 individuals were included. Plasma renin activity was reduced after exercise training (n= 7 trials, standardized mean difference -0.25 (95% CL -0.5 to -0.001), P=0.049), whereas no effect was observed on serum aldosterone ((n= 3 trials; standardized mean difference -0.79 (-1.97 to +0.39)) or angiotensin II (n=3 trials; standardized mean difference -0.16 (-0.61 to +0.30). Significant reductions in systolic blood pressure -5.65 mm Hg (-8.12 to -3.17) and diastolic blood pressure -3.64 mm Hg (-5.4 to -1.91) following exercise training were observed. No relation was found between net changes in plasma renin activity and net changes in blood pressure (P>0.05). To conclude, although we observed a significant reduction in plasma renin activity following exercise training this was not related to the observed blood pressure reduction. Given the small number of studies and small sample sizes, larger well-controlled randomized studies are required to confirm our results and to investigate the potential role of the RAAS in the observed improvements in blood pressure following exercise training.
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La Favor JD, Kraus RM, Carrithers JA, Roseno SL, Gavin TP, Hickner RC. Sex differences with aging in nutritive skeletal muscle blood flow: impact of exercise training, nitric oxide, and α-adrenergic-mediated mechanisms. Am J Physiol Heart Circ Physiol 2015; 307:H524-32. [PMID: 24951753 DOI: 10.1152/ajpheart.00247.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The incidence of cardiovascular disease increases progressively with age, but aging may affect men and women differently. Age-associated changes in vascular structure and function may manifest in impaired nutritive blood flow, although the regulation of nutritive blood flow in healthy aging is not well understood. The purpose of this study was to determine if nitric oxide (NO)-mediated or α-adrenergic-mediated regulation of nutritive skeletal muscle blood flow is impaired with advanced age, and if exercise training improves age-related deficiencies. Nutritive blood flow was monitored in the vastus lateralis of healthy young and aged men and women via the microdialysis-ethanol technique prior to and following seven consecutive days of exercise training. NO-mediated and α-adrenergic-mediated regulation of nutritive blood flow was assessed by microdialysis perfusion of acetylcholine, sodium nitroprusside, N(G)-monomethyl-L-arginine, norepinephrine, or phentolamine. Pretraining nutritive blood flow was attenuated in aged compared with young women (7.39 ± 1.5 vs. 15.5 ± 1.9 ml·100 g(−1)·min(−1), P = 0.018), but not aged men (aged 13.5 ± 3.7 vs. young 9.4 ± 1.3 ml·100 g(−1)·min(−1), P = 0.747). There were no age-associated differences in NO-mediated or α-adrenergic-mediated nutritive blood flow. Exercise training increased resting nutritive blood flow only in young men (9.4 ± 1.3 vs. 19.7 ml·100 g(−1)·min(−1), P = 0.005). The vasodilatory effect of phentolamine was significantly reduced following exercise training only in young men (12.3 ± 6.14 vs. −3.68 ± 3.26 ml·100 g(−1)·min(−1), P = 0.048). In conclusion, the age-associated attenuation of resting nutritive skeletal muscle blood flow was specific to women, while the exercise-induced alleviation of α-adrenergic mediated vasoconstriction that was specific to young men suggests an age-associated modulation of the sympathetic response to exercise training.
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Age-Related Cognitive Impairment as a Sign of Geriatric Neurocardiovascular Interactions: May Polyphenols Play a Protective Role? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:721514. [PMID: 26180593 PMCID: PMC4477224 DOI: 10.1155/2015/721514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/02/2014] [Indexed: 12/18/2022]
Abstract
It is known that endothelial dysfunction plays an important role in the development and progression of cardiovascular diseases implicated also in cognitive decline. Experimental studies pointed to the fact that the modification of NO levels via NOS activity may affect the blood pressure level as well as several higher nervous functions—for example, learning and memory. There are emerging evidences from in vitro and animal studies suggesting that polyphenols may potentially have a protective effect on the development of neurodegenerative diseases and may improve cognitive function as well as positively affecting the blood pressure regulatory mechanisms. This review accentuates the need for precisely defined clinically controlled studies as well as for use of adequate experimental procedures discriminating between the human higher brain functions and the only overall activation of the brain cortex. The physiological neurocardiovascular interactions are implicated in the increased healthy life span as well.
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Prescribing Medication Versus Promoting Behavioural Change: A Trial of the Use of Lifestyle Management to Replace Drug Treatment of Hypertension in General Practice. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/s0813483900005076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Antihypertensive drug therapy may reverse the cardiac and vascular structural changes associated with sustained hypertension. This may enable appropriate blood pressure levels to be maintained with milder forms of therapy (such as lifestyle interventions) which will minimise any potential adverse effects of pharmacological therapy. The HEART project was conducted in the general practice setting and aimed to determine whether lifestyle strategies, such as increased physical activity and dietary modification, could be substituted for drug therapy in patients who had been well controlled on antihypertensive medication. In addition to objective measures of blood pressure and risk factor outcomes, attitudes and perceptions of general practitioners (GPs) and patients involved in the trial were assessed through focus group discussion and personal interviews. Of the 44 patients recruited to the trial, 41 (93%) participated in structured interviews of 20–40 minutes duration conducted in person or by telephone. Of 78 GPs working in the western suburbs of Melbourne who were approached about the trial, 50% were willing to participate. Of these, 13 (34%) recruited study patients. Of these 13, 10 (77%) participated in a 2-hour focus group discussion which was audiotaped for later transcription and analysis. Despite being enthusiastic about lifestyle interventions in principle, nearly all of these GPs felt resistant to the concept of withdrawing medication in well-controlled subjects. They were generally surprised to see that many patients (15 of 20 patients: 75%) were able to maintain appropriate blood pressure levels following drug therapy withdrawal and adoption of minimal lifestyle changes. GPs felt that the patients' eagerness to come off medication was the major incentive for patients to participate in the trial. This was corroborated by many patients indicating a desire not to be taking any medication. The majority of patients reported making minor changes in lifestyle behaviours leading to most being able to remain off therapy or to have drug dosage requirements reduced. The major barriers to maintaining lifestyle change were family and work stresses and the perception of the intervention not being treated as a therapy thus not at the same level of importance as a treatment method as drug therapy. It appears that a select group of hypertensive patients, highly motivated by the prospect of drug therapy withdrawal, were interested in and willing to trial a lifestyle behaviour change approach for their blood pressure management. The majority reported that they had been able to adopt small but meaningful changes in exercise and dietary habits through the provision of stand-alone self-help materials and support from their GP. Of these patients, 75% remained normotensive without drug therapy after a 9-month follow-up period.
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Albarwani S, Al-Siyabi S, Tanira MO. Prehypertension: Underlying pathology and therapeutic options. World J Cardiol 2014; 6:728-43. [PMID: 25228952 PMCID: PMC4163702 DOI: 10.4330/wjc.v6.i8.728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/08/2014] [Accepted: 06/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.
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Affiliation(s)
- Sulayma Albarwani
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Sultan Al-Siyabi
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Musbah O Tanira
- Sulayma Albarwani, Sultan Al-Siyabi, Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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Seron P, Lanas F, Pardo Hernandez H, Bonfill Cosp X, Cochrane Heart Group. Exercise for people with high cardiovascular risk. Cochrane Database Syst Rev 2014; 2014:CD009387. [PMID: 25120097 PMCID: PMC6669260 DOI: 10.1002/14651858.cd009387.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND When two or more cardiovascular risk factors occur in one individual, they may interact in a multiplicative way promoting cardiovascular disease. Exercise has proven to be effective in controlling individual risk factors but its effect on overall cardiovascular risk remains uncertain. OBJECTIVES To assess the effects of exercise training in people with increased cardiovascular risk but without a concurrent cardiovascular disease on general cardiovascular mortality, incidence of cardiovascular events, and total cardiovascular risk. SEARCH METHODS A search was conducted in CENTRAL (The Cochrane Library 2013, Issue 10 of 12), Ovid MEDLINE (1946 to week 2 November 2013), EMBASE Classic + EMBASE via Ovid (1947 to Week 47 2013), CINAHL Plus with Full Text via EBSCO (to November 2013), Science Citation Index Expanded (SCI-EXPANDED) (1970 to 22 November 2013), and Conference Proceedings Citation Index - Science (CPCI-S) (1990 to 22 November 2013) on Web of Science (Thomson Reuters). We did not apply any date or language restrictions. SELECTION CRITERIA Randomized clinical trials comparing aerobic or resistance exercise training versus no exercise or any standard approach that does not include exercise. Participants had to be 18 years of age or older with an average 10-year Framingham risk score of 10% for cardiovascular disease over 10 years, or with two or more cardiovascular risk factors, and no history of cardiovascular disease. DATA COLLECTION AND ANALYSIS The selection of studies and subsequent data collection process were conducted by two independent authors. Disagreements were solved by consensus. The results were reported descriptively. It was not possible to conduct a meta-analysis because of the high heterogeneity and high risk of bias in the included studies. MAIN RESULTS A total of four studies were included that involved 823 participants, 412 in the exercise group and 411 in the control group. Follow-up of participants ranged from 16 weeks to 6 months. Overall, the included studies had a high risk of selection, detection, and attrition bias. Meta-analysis was not possible because the interventions (setting, type and intensity of exercise) and outcome measurements were not comparable, and the risk of bias in the identified studies was high. No study assessed cardiovascular or all‑cause mortality or cardiovascular events as individual outcomes. One or more of the studies reported on total cardiovascular risk, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, blood pressure, body mass index, exercise capacity, and health-related quality of life but the available evidence was not sufficient to determine the effectiveness of exercise. Adverse events and smoking cessation were not assessed in the included studies. AUTHORS' CONCLUSIONS Evidence to date is entirely limited to small studies with regard to sample size, short-term follow-up, and high risk of methodological bias, which makes it difficult to derive any conclusions on the efficacy or safety of aerobic or resistance exercise on groups with increased cardiovascular risk or in individuals with two or more coexisting risk factors. Further randomized clinical trials assessing controlled exercise programmes on total cardiovascular risk in individuals are warranted.
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Affiliation(s)
- Pamela Seron
- Facultad de Medicina, Universidad de La FronteraCIGES ‐ Departamento de Medicina InternaMontt112, 3º piso.TemucoAraucaniaChile4780000
| | - Fernando Lanas
- Facultad de Medicina, Universidad de La FronteraCIGES ‐ Departamento de Medicina InternaMontt112, 3º piso.TemucoAraucaniaChile4780000
| | - Hector Pardo Hernandez
- Biomedical Research Institute Sant Pau (IIB Sant Pau)Iberoamerican Cochrane CentreC. Sant Antoni Maria Claret 171BarcelonaCatalunyaSpain08041
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaCataloniaSpain08025
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Lawrence MM, Cooley ID, Huet YM, Arthur ST, Howden R. Factors influencing isometric exercise training-induced reductions in resting blood pressure. Scand J Med Sci Sports 2014; 25:131-42. [DOI: 10.1111/sms.12225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 01/13/2023]
Affiliation(s)
- M. M. Lawrence
- Laboratory of Systems Physiology; Department of Kinesiology; University of North Carolina at Charlotte; Charlotte North Carolina USA
| | - I. D. Cooley
- Laboratory of Systems Physiology; Department of Kinesiology; University of North Carolina at Charlotte; Charlotte North Carolina USA
| | - Y. M. Huet
- Laboratory of Systems Physiology; Department of Kinesiology; University of North Carolina at Charlotte; Charlotte North Carolina USA
| | - S. T. Arthur
- Laboratory of Systems Physiology; Department of Kinesiology; University of North Carolina at Charlotte; Charlotte North Carolina USA
| | - R. Howden
- Laboratory of Systems Physiology; Department of Kinesiology; University of North Carolina at Charlotte; Charlotte North Carolina USA
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Wissing KM, Pipeleers L. Obesity, metabolic syndrome and diabetes mellitus after renal transplantation: prevention and treatment. Transplant Rev (Orlando) 2013; 28:37-46. [PMID: 24507957 DOI: 10.1016/j.trre.2013.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/18/2013] [Indexed: 02/06/2023]
Abstract
The prevalence of the metabolic syndrome in dialysis patients is high and further increases after transplantation due to weight gain and the detrimental metabolic effects of immunosuppressive drugs. Corticosteroids cause insulin resistance, hyperlipidemia, abnormal glucose metabolism and arterial hypertension. The calcineurin inhibitor tacrolimus is diabetogenic by inhibiting insulin secretion, whereas cyclosporine causes hypertension and increases cholesterol levels. Mtor antagonists are responsible for hyperlipidemia and abnormal glucose metabolism by mechanisms that also implicate insulin resistance. The metabolic syndrome in transplant recipients has numerous detrimental effects such as increasing the risk of new onset diabetes, cardiovascular disease events and patient death. In addition, it has also been linked with accelerated loss of graft function, proteinuria and ultimately graft loss. Prevention and management of the metabolic syndrome are based on increasing physical activity, promotion of weight loss and control of cardiovascular risk factors. Bariatric surgery before or after renal transplantation in patients with body mass index >35 kg/m(2) is an option but its long term effects on graft and patient survival have not been investigated. Steroid withdrawal and replacement of tacrolimus with cyclosporine facilitate control of diabetes, whereas replacement of cyclosporine and mtor antagonists can improve hyperlipidemia. The new costimulation inhibitor belatacept has potent immunosuppressive properties without metabolic adverse effects and will be an important component of immunosuppressive regimens with better metabolic risk profile. Medical treatment of cardiovascular risk factors has to take potential drug interactions with immunosuppressive medication and drug accumulation due to renal insufficiency into account.
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Affiliation(s)
- Karl Martin Wissing
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Nephrology and Dialysis Clinic, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
| | - Lissa Pipeleers
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Hecksteden A, Grütters T, Meyer T. Associations between acute and chronic effects of exercise on indicators of metabolic health: a pilot training trial. PLoS One 2013; 8:e81181. [PMID: 24278393 PMCID: PMC3836744 DOI: 10.1371/journal.pone.0081181] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The interindividual variability in the health-related efficacy of regular endurance training is high. This impedes on the individual optimization of preventive training prescriptions when optimal efficacy is intended. As a consequence, health-gains remain below what could be achieved. Practicable predictors of an individual's responsiveness to physical exercise would offer a solution to this problem. Therefore, the present study aims to test the association of acute changes in indicators of metabolic health after an exhaustive exercise test and the respective chronic changes in response to an endurance training program. METHODS Fasting blood samples of healthy, untrained, non-smoking subjects (n=12, age 49 ± 7 years; body mass index 29 ± 4; maximum oxygen uptake 34 ± 7 ml · min(-1) · kg(-1)) were collected before and 1 hour after an exhaustive exercise test as well as after a 4 week supervised training period (walking / running 4 times per week at 60 % heart rate reserve). RESULTS A close linear relationship between acute and chronic changes could be demonstrated for insulin concentration (p=0.001; r=0.83), the fasting indicator of insulin sensitivity HOMA-IR (p<0.001; r=0.78) and non-esterified fatty acid concentration (p=0.001; r=0.88). No association became apparent for standard blood lipid parameters. CONCLUSION It is concluded that the magnitude of acute exercise-induced changes in indicators of insulin sensitivity and non-esterified fatty acid concentration is a promising candidate for the prediction of chronic training induced changes in the respective parameter. However, further studies are needed to assess predictive accuracy. TRIAL REGISTRATION www.clinicaltrials.gov NCT00934206 http://www.clinicaltrials.gov/ct2/show/NCT00934206.
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Affiliation(s)
- Anne Hecksteden
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- * E-mail:
| | - Teresa Grütters
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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Abstract
Background and Purpose. Physical activity is beneficial after stroke, but it is unclear how active stroke survivors are. This systematic review and meta-analysis sought to determine levels of activity and factors predicting activity. Summary of Review: Methods. MEDLINE (1946 to present) and EMBASE (1980 to present) were systematically searched until July 2012. All studies quantifying whole-body-free living physical activity by objective and self-reported methods in a community dwelling population with stroke were included. A random effect meta-analysis was performed. Results. Twenty-six studies were included (n=1105), of which eleven (n=315) contained sufficient data for meta-analysis. There were heterogeneous designs, measurements, and procedures. The studies generally recruited small samples of high-functioning participants. Level of physical activity was generally low in quantity, duration and intensity. Poorer walking ability, specific sensorimotor functions, and low mood were correlates of low physical activity. Meta-analysis generated an estimate of 4355.2 steps/day (95% CI: 3210.4 to 5499.9) with no significant heterogeneity (I2 = 0). Conclusions. In high-functioning stroke survivors, physical activity including walking was generally low. Strategies are needed to promote and maintain physical activity in stroke survivors. Research is needed to establish reasons for low physical activity after stroke.
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Ye HH, Jeong JU, Jeon MJ, Sakong J. The Association between Shift Work and the Metabolic Syndrome in Female Workers. Ann Occup Environ Med 2013; 25:33. [PMID: 24472469 PMCID: PMC3923341 DOI: 10.1186/2052-4374-25-33] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/08/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study aimed to determine identify any association between shift work and the metabolic syndrome by comparing the prevalence rates of the metabolic syndrome in shift work groups and daytime work groups for female workers. METHODS Based on data from health examinations carried out from April to December of 2012, we selected as our subjects 254 female workers from the Daegu area Dyeing Industrial Complex. We diagnosed the metabolic syndrome using the examination results, and information about age, whether or not they did shift work, job type, smoking habits, drinking habits, exercise habits, and past medical history was collected through self-administered questionnaire surveys and face-to-face interviews. The variables found in a univariate analysis to be significant in the occurrence of the metabolic syndrome - age, drinking habits, exercise habits, and shift work - were included in a logistic regression analysis of the risk of the metabolic syndrome for female workers. RESULTS The prevalence rates of the metabolic syndrome for the total group of study subjects was 11.8%, for daytime workers was 2.8%, and for shift workers was 15.3%. A logistic regression analysis of the odds of the metabolic syndrome for female workers was conducted that included factors associated with the occurrence of the metabolic syndrome: age, drinking habits, exercise habits, and shift work. The results revealed that the odds ratio of the metabolic syndrome in the shift work group, 6.30 (95% CI 1.24-32.15), was significantly higher when compared with the daytime work group. CONCLUSION Shift work appears to have an association with the metabolic syndrome in female workers. Accordingly, we believe that the attention of government agencies and business owners is needed together with the individual practice of health behaviors to manage the metabolic syndrome for the prevention of cardiovascular disease in female shift workers.
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Affiliation(s)
| | | | - Man Joong Jeon
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, 317-1, Daemyungdong, Namgu, Daegu 705-717, Republic of Korea.
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Siebel AL, Carey AL, Kingwell BA. Can exercise training rescue the adverse cardiometabolic effects of low birth weight and prematurity? Clin Exp Pharmacol Physiol 2013; 39:944-57. [PMID: 22882133 DOI: 10.1111/j.1440-1681.2012.05732.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Being born preterm and/or small for gestational age are well-established risk factors for cardiometabolic disease in adulthood. Physical activity has the potential to mitigate against the detrimental cardiometabolic effects of low birth weight from two perspectives: (i) maternal exercise prior to and during pregnancy; and (ii) exercise during childhood or adulthood for those born small or prematurely. Evidence from epidemiological birth cohort studies suggests that the effects of moderate-intensity physical activity during pregnancy on mean birth weight are small, but reduce the risk of either high or low birth weight infants. In contrast, vigorous and/or high-intensity exercise during pregnancy has been associated with reduced birth weight. In childhood and adolescence, exercise ability is compromised in extremely low birth weight individuals (< 1000 g), but only marginally reduced in those of very low to low birth weight (1000-2500 g). Epidemiological studies show that the association between birth weight and metabolic disease is lost in physically fit individuals and, consistently, that the association between low birth weight and metabolic syndrome is accentuated in unfit individuals. Physical activity intervention studies indicate that most cardiometabolic risk factors respond to exercise in a protective manner, independent of birth weight. The mechanisms by which exercise may protect low birth weight individuals include restoration of muscle mass, reduced adiposity and enhanced β-cell mass and function, as well as effects on both aerobic and anaerobic muscle metabolism, including substrate utilization and mitochondrial function. Vascular and cardiac adaptations are also likely important, but are less well studied.
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Affiliation(s)
- Andrew L Siebel
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Effects of isometric handgrip training dose on resting blood pressure and resistance vessel endothelial function in normotensive women. Eur J Appl Physiol 2013; 113:2091-100. [PMID: 23588257 DOI: 10.1007/s00421-013-2644-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/08/2013] [Indexed: 10/27/2022]
Abstract
Isometric handgrip (IHG) training lowers resting blood pressure (BP) in both hypertensives and normotensives, yet the effect of training dose on the magnitude of reduction and the mechanisms associated with the hypotensive response are elusive. We investigated, in normotensive women, the effects of two different doses of IHG training on resting BP, and explored improved resistance vessel endothelial function and heart rate variability (HRV) as potential mechanisms of BP reduction. Resting BP, HRV, and resistance vessel endothelial function (venous strain-gauge plethysmography with reactive hyperemia) were assessed in 32 women before and after 4 and 8 weeks of 3×/week (n = 12) or 5×/week (n = 11) IHG training (four, 2-min unilateral contractions at 30 % maximal voluntary contraction), or 0×/week control (n = 9). IHG training decreased systolic BP in the 3×/week (94 ± 6 to 91 ± 6 to 88 ± 5 mmHg, pre- to mid- to post-training; P < 0.01) and 5×/week (97 ± 11 to 90 ± 9 to 91 ± 9 mmHg, P < 0.01) groups, concomitant with increased forearm reactive hyperemic blood flow (26 ± 7 to 30 ± 8 to 36 ± 9 mL/min/100 mL tissue, P < 0.01; and 26 ± 7 to 29 ± 7 to 38 ± 13 mL/min/100 mL tissue, P < 0.01, respectively), yet both remained unchanged in the control group. No changes were observed in diastolic BP, mean arterial BP, or any indices of HRV in any group (all P > 0.05). In conclusion, IHG training lowers resting systolic BP and improves resistance vessel endothelial function independent of training dose in normotensive women.
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McDonnell BJ, Maki-Petaja KM, Munnery M, Wilkinson IB, Cockcroft JR, McEniery CM. Habitual exercise and blood pressure: age dependency and underlying mechanisms. Am J Hypertens 2013; 26:334-41. [PMID: 23382483 DOI: 10.1093/ajh/hps055] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Regular exercise is associated with a reduction in cardiovascular risk, but the precise mechanisms responsible are unknown. The aim of the current study was to examine the relationship between regular exercise, aortic stiffness, and wave reflections, and to determine whether this relationship differs by age. METHODS Younger (<30 years) and older (>50 years) individuals, who were either sedentary or undertook regular aerobic exercise, were drawn from the Anglo-Cardiff Collaborative Trial population. This yielded 1,036 individuals, all of whom were nonsmokers, and were free of cardiovascular disease and medication. All individuals undertook a detailed lifestyle and medical history questionnaire including details of physical activity. Brachial and central blood pressure, together with aortic stiffness, wave reflections, cardiac output, and peripheral vascular resistance were assessed in all individuals. RESULTS In younger individuals, regular exercise was associated with lower diastolic blood pressure but elevated pulse pressure. In contrast, both systolic and pulse pressure were lower in older active individuals, compared with their sedentary counterparts. Moreover, regular exercise was associated with lower wave reflections and peripheral vascular resistance in younger individuals, but lower large artery stiffness in older individuals. CONCLUSIONS These data suggest that regular exercise is associated with a beneficial vascular profile. However, this differs between younger and older individuals such that the smaller preresistance and resistance vessels are involved in younger individuals whereas the large elastic arteries are involved in older individuals. Despite these differential findings, the current data provide support for strategies that increase habitual physical activity levels in the general population.
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Affiliation(s)
- Barry J McDonnell
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
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Davis RT, Stabley JN, Dominguez JM, Ramsey MW, McCullough DJ, Lesniewski LA, Delp MD, Behnke BJ. Differential effects of aging and exercise on intra-abdominal adipose arteriolar function and blood flow regulation. J Appl Physiol (1985) 2013; 114:808-15. [PMID: 23349454 DOI: 10.1152/japplphysiol.01358.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Adipose tissue (AT), which typically comprises an increased percentage of body mass with advancing age, receives a large proportion of resting cardiac output. During exercise, an old age-associated inability to increase vascular resistance within the intra-abdominal AT may compromise the ability of the cardiovascular system to redistribute blood flow to the active musculature, contributing to the decline in exercise capacity observed in this population. We tested the hypotheses that 1) there would be an elevated perfusion of AT during exercise with old age that was associated with diminished vasoconstrictor responses of adipose-resistance arteries, and 2) chronic exercise training would mitigate the age-associated alterations in AT blood flow and vascular function. Young (6 mo; n = 40) and old (24 mo; n = 28) male Fischer 344 rats were divided into young sedentary (YSed), old sedentary (OSed), young exercise trained (YET), or old exercise trained (OET) groups, where training consisted of 10-12 wk of treadmill exercise. In vivo blood flow at rest and during exercise and in vitro α-adrenergic and myogenic vasoconstrictor responses in resistance arteries from AT were measured in all groups. In response to exercise, there was a directionally opposite change in AT blood flow in the OSed group (≈ 150% increase) and YSed (≈ 55% decrease) vs. resting values. Both α-adrenergic and myogenic vasoconstriction were diminished in OSed vs. YSed AT-resistance arteries. Exercise training resulted in a similar AT hyperemic response between age groups during exercise (YET, 9.9 ± 0.5 ml · min(-1) · 100(-1) g; OET, 8.1 ± 0.9 ml · min(-1) · 100(-1) g) and was associated with enhanced myogenic and α-adrenergic vasoconstriction of AT-resistance arteries from the OET group relative to OSed. These results indicate that there is an inability to increase vascular resistance in AT during exercise with old age, due, in part, to a diminished vasoconstriction of AT arteries. Furthermore, the results indicate that exercise training can augment vasoconstriction of AT arteries and mitigate age-related alterations in the regulation of AT blood flow during exercise.
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Affiliation(s)
- Robert T Davis
- Department of Applied Physiology and Kinesiology and Center for Exercise Science, University of Florida, Gainesville, Florida 32611, USA
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Association between postexercise hypotension and long-term training-induced blood pressure reduction: a pilot study. Clin J Sport Med 2013; 23:58-63. [PMID: 22673537 DOI: 10.1097/jsm.0b013e31825b6974] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The interindividual variability in the efficacy of regular endurance exercise to lower blood pressure is high. Therefore, to optimize training prescriptions, predictors would be desirable. The main hypothesis of the present study was an association between postexercise hypotension after an exhaustive exercise test and chronic blood pressure reductions in response to an endurance training program. DESIGN Uncontrolled prospective training study. SETTING University department. PARTICIPANTS Healthy untrained subjects were recruited by flyers. Inclusion criteria were age 30 to 60 years, body mass index 25 to 35 kg/m(2), untrained status (<1 hour/week regular activity; V[Combining Dot Above]O(2max) < 45 mL·min(-1)·kg(-1)), blood pressure 150/95 mm Hg, nonsmoker; 14 subjects were included, 12 could be analyzed. INTERVENTION Walking/running 4 times per week at 60% heart rate reserve for 4 weeks. MAIN OUTCOME MEASURES Difference in blood pressure from the initial resting value to 1 and 24 hours after the initial test (acute) and the resting value before the final test (chronic), respectively. RESULTS Initial resting systolic blood pressure was 134 ± 18 mm Hg. Values were significantly reduced at all time points thereafter (1 hour: 125 ± 13 mm Hg; 24 hours: 128 ± 12 mm Hg; final: 125 ± 18 mm Hg). Acute and chronic changes correlated significantly (1 hour: P = 0.003; r = 0.77; 24 hours: P = 0.017; r = 0.67). Results for diastolic blood pressure were comparable yet less pronounced. CONCLUSIONS The magnitude of postexercise hypotension is a promising candidate for the prediction of individual blood pressure-related training efficacy. Easily determined, it might be used to improve training prescriptions. However, further studies are needed to assess predictive accuracy.
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Latouche C, Jowett JBM, Carey AL, Bertovic DA, Owen N, Dunstan DW, Kingwell BA. Effects of breaking up prolonged sitting on skeletal muscle gene expression. J Appl Physiol (1985) 2012; 114:453-60. [PMID: 23271697 DOI: 10.1152/japplphysiol.00978.2012] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Breaking up prolonged sitting has been beneficially associated with cardiometabolic risk markers in both observational and intervention studies. We aimed to define the acute transcriptional events induced in skeletal muscle by breaks in sedentary time. Overweight/obese adults participated in a randomized three-period, three-treatment crossover trial in an acute setting. The three 5-h interventions were performed in the postprandial state after a standardized test drink and included seated position with no activity and seated with 2-min bouts of light- or moderate-intensity treadmill walking every 20 min. Vastus lateralis biopsies were obtained in eight participants after each treatment, and gene expression was examined using microarrays validated with real-time quantitative PCR. There were 75 differentially expressed genes between the three conditions. Pathway analysis indicated the main biological functions affected were related to small-molecule biochemistry, cellular development, growth and proliferation, and carbohydrate metabolism. Interestingly, differentially expressed genes were also linked to cardiovascular disease. For example, relative to prolonged sitting, activity bouts increased expression of nicotamide N-methyltransferase, which modulates anti-inflammatory and anti-oxidative pathways and triglyceride metabolism. Activity bouts also altered expression of 10 genes involved in carbohydrate metabolism, including increased expression of dynein light chain, which may regulate translocation of the GLUT-4 glucose transporter. In addition, breaking up sedentary time reversed the effects of chronic inactivity on expression of some specific genes. This study provides insight into the muscle regulatory systems and molecular processes underlying the physiological benefits induced by interrupting prolonged sitting.
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Affiliation(s)
- Celine Latouche
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Lin Y, Kawamura T, Anno T, Ichihara Y, Ohta T, Saito M, Fujioka Y, Kimura M, Okada T, Kuwayama Y, Wakai K, Ohno Y. A study on how a 6-month aerobic exercise program can modify coronary risk factors depending on their severity in middle-aged sedentary women. Environ Health Prev Med 2012; 4:117-21. [PMID: 21432183 DOI: 10.1007/bf02932266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/1998] [Accepted: 07/01/1999] [Indexed: 02/06/2023] Open
Abstract
It is well known that physical exercise can reduce coronary risk factors. But how an aerobic exercise modifies coronary risk factors in relation to severity and physical fitness is still controversial.Fifty-four middle-aged women (mean age, 55 years) completed a 6-month on-site and home-based anaerobic threshold-level exercise program. The changes in coronary risk factor profiles were observed during the pre-intervention and intervention periods. Before the intervention (during control period), most coronary risk factors showed a rather unfavorable trend. After the program, their mean body weight decreased from 56.7 to 55.7 kg (p>0.05) and the proportion of body fat from 30.9 to 27.9% (p>0.05) without any reduction in lean body mass. Systolic blood pressure (SBP) decreased from 129.0 to 125.0 mm Hg (p>0.05) and diastolic blood pressure from 79.5 to 76.6 mm Hg (p>0.05). Fasting plasma glucose (FPG) declined from 109.6 to 103.4 mg/dl (p>0.05). Changes in SBP and FPG were most remarkable in their respective worst tertile. Serum lipids improved only modestly. Maximum oxygen uptake increased from 23.6 to 26.1 ml/kg/min (p>0.01). However, no significant correlations were found between changes in coronary risk factors and those in physical fitness. We conclude that the 6-month aerobic exercise program would modify women's coronary risk factors depending on their initial values, probably independently of the changes in physical fitness.
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Affiliation(s)
- Y Lin
- Department of Preventive Medicine, Nagoya University School of Medicine, 65 Tsurumai-cho, 466-8550, Showaku, Nagoya, Japan,
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Whayne TF, Maulik N. Nutrition and the healthy heart with an exercise boost. Can J Physiol Pharmacol 2012; 90:967-76. [DOI: 10.1139/y2012-074] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this era of potent medications and major cardiovascular (CV) procedures, the value of nutrition can be forgotten. A healthy diet is essential, regardless of CV risk. Caloric balance is inherent to a good diet. Despite patients who say they eat little, ideal weight can be maintained if calories are burned. Composition is another component of a healthy diet. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets provide proof of CV benefit from their specific content. Metabolic syndrome (MS) is associated with poor diet and obesity. A healthy diet with good nutrition benefits the MS patient and associated conditions such as obesity and diabetes. Exercise, in conjunction with a healthy diet and good nutrition, helps maintain optimal weight and provides CV benefit such as decreased inflammation and increased vasodilatation. Whether vitamins or other nutritional supplements are important in a healthy diet is unproven. Nevertheless, the most promising data of added benefit to a healthy diet is with vitamin D. Some dietary supplements also have promise. Alcohol, in moderation, especially red wine, has nutritional and heart protective benefits. Antioxidants, endogenous or exogenous, have received increased interest and appear to play a favorable nutritional role. CV health starts with good nutrition.
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Affiliation(s)
- Thomas F. Whayne
- Gill Heart Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Nilanjana Maulik
- Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1110, USA
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Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, Shaw JE, Bertovic DA, Zimmet PZ, Salmon J, Owen N. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care 2012; 35:976-83. [PMID: 22374636 PMCID: PMC3329818 DOI: 10.2337/dc11-1931] [Citation(s) in RCA: 831] [Impact Index Per Article: 63.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Observational studies show breaking up prolonged sitting has beneficial associations with cardiometabolic risk markers, but intervention studies are required to investigate causality. We examined the acute effects on postprandial glucose and insulin levels of uninterrupted sitting compared with sitting interrupted by brief bouts of light- or moderate-intensity walking. RESEARCH DESIGN AND METHODS Overweight/obese adults (n = 19), aged 45-65 years, were recruited for a randomized three-period, three-treatment acute crossover trial: 1) uninterrupted sitting; 2) seated with 2-min bouts of light-intensity walking every 20 min; and 3) seated with 2-min bouts of moderate-intensity walking every 20 min. A standardized test drink was provided after an initial 2-h period of uninterrupted sitting. The positive incremental area under curves (iAUC) for glucose and insulin (mean [95% CI]) for the 5 h after the test drink (75 g glucose, 50 g fat) were calculated for the respective treatments. RESULTS The glucose iAUC (mmol/L) · h after both activity-break conditions was reduced (light: 5.2 [4.1-6.6]; moderate: 4.9 [3.8-6.1]; both P < 0.01) compared with uninterrupted sitting (6.9 [5.5-8.7]). Insulin iAUC (pmol/L) · h was also reduced with both activity-break conditions (light: 633.6 [552.4-727.1]; moderate: 637.6 [555.5-731.9], P < 0.0001) compared with uninterrupted sitting (828.6 [722.0-950.9]). CONCLUSIONS Interrupting sitting time with short bouts of light- or moderate-intensity walking lowers postprandial glucose and insulin levels in overweight/obese adults. This may improve glucose metabolism and potentially be an important public health and clinical intervention strategy for reducing cardiovascular risk.
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Affiliation(s)
- David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Akber A, Portale AA, Johansen KL. Pedometer-assessed physical activity in children and young adults with CKD. Clin J Am Soc Nephrol 2012; 7:720-6. [PMID: 22422539 DOI: 10.2215/cjn.06330611] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Data on physical activity are limited in children with CKD. The objectives of this study were to measure the level and correlates of physical activity in children and young adults with CKD and to determine the association of physical activity with physical performance and physical functioning. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Physical activity was measured for 7 days using pedometers; physical performance was measured by the 6-minute walk distance (6MWD) and physical functioning with the PedsQL 4.0. RESULTS Study participants were 44 patients 7-20 years of age who had CKD stage 1-4 (n=12), had ESRD and were undergoing dialysis (n=7), or had undergone kidney transplantation (n=25). Participants were very sedentary; they walked 6218 (interquartile range, 3637, 9829) steps per day, considerably less than recommended. Physical activity did not differ among participants in the CKD stage 1-4, ESRD, and transplant groups. Females were less active than males (P<0.01), and physical activity was 44% lower among young adults (18-20 years) than younger participants (P<0.05). Physical activity was associated positively with maternal education and hemoglobin concentration and inversely with body mass index. Respective 6MWD in males and females was 2 and approximately 4 SDs below expected. Low levels of physical activity were associated with poor physical performance and physical functioning, after adjustment for age, sex, and body mass index. CONCLUSIONS In most participants with CKD, physical activity was considerably below recommended levels. Future studies are needed to determine whether increasing physical activity can improve physical performance and physical functioning.
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Affiliation(s)
- Aalia Akber
- Department of Pediatrics, Division of Pediatric Nephrology, University of California, San Francisco, San Francisco, California, USA
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44
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Chan W, Dart AM. Vascular stiffness and aging in HIV. Sex Health 2012; 8:474-84. [PMID: 22127032 DOI: 10.1071/sh10160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/31/2011] [Indexed: 12/19/2022]
Abstract
Large artery stiffening is a biological index of vascular aging. Vascular aging and atherosclerosis are two closely linked processes that develop in parallel and in synergy, sharing common aetiological determinants. Vascular stiffening increases left ventricular work and can lead to diminished coronary perfusion, and may therefore contribute to the development of cardiovascular disease. There is emerging evidence that large artery stiffness and vascular aging are accelerated in HIV infection because of the high prevalence of cardiovascular risk factors among HIV-infected patients. Moreover, the biological effects of HIV and the metabolic perturbations associated with antiretroviral therapies appear to accelerate vascular stiffening in HIV-infected patients. Further studies evaluating the effects of general and targeted therapies and various combinations of antiretroviral therapies on measures of large artery stiffness are urgently needed.
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Affiliation(s)
- William Chan
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Vic. 3004, Australia
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Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Ž, Cornelissen V, Adamopoulos S, Prescott E, Börjesson M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (Part II). Eur J Prev Cardiol 2011; 19:1005-33. [DOI: 10.1177/1741826711430926] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - N Geladas
- University of Athens, Athens, Greece
| | - D Hansen
- University Hasselt, Diepenbeek, Belgium
| | - E Kouidi
- Aristotle University, Thessaloniki, Greece
| | - J Niebauer
- Paracelsus Medical University, Salzburg, Austria
| | - Ž Reiner
- University Hospital Center Zagreb, Zagreb, Croatia
| | | | | | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
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Gallanagh S, Quinn TJ, Alexander J, Walters MR. Physical activity in the prevention and treatment of stroke. ISRN NEUROLOGY 2011; 2011:953818. [PMID: 22389836 PMCID: PMC3263535 DOI: 10.5402/2011/953818] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 08/04/2011] [Indexed: 12/17/2022]
Abstract
The role of physical activity in the prevention of stroke is of great interest due to the high mortality and significant impact of stroke-related morbidity on the individual and on healthcare resources. The use of physical activity as a therapeutic strategy to maximise functional recovery in the rehabilitation of stroke survivors has a growing evidence base. This narrative review examines the existing literature surrounding the use of exercise and physical therapy in the primary and secondary prevention of stroke. It explores the effect of gender, exercise intensities and the duration of observed benefit. It details the most recent evidence for physical activity in improving functional outcome in stroke patients. The review summaries the current guidelines and recommendations for exercise therapy and highlights areas in which further research and investigation would be useful to determine optimal exercise prescription for effective prevention and rehabilitation in stroke.
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Affiliation(s)
| | - Terry J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G11 6NT, UK
| | - Jen Alexander
- Department of Physiotherapy, Western Infirmary, Glasgow G11 6NT, UK
| | - Matthew R. Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G11 6NT, UK
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Previous leisure-time physical activity dose dependently decreases ischemic stroke severity. Stroke Res Treat 2011; 2012:614925. [PMID: 21912754 PMCID: PMC3168295 DOI: 10.1155/2012/614925] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 11/17/2022] Open
Abstract
In the present subanalysis of a cross-sectional study showing the favorable effect of prior transient ischemia, leisure-time physical activity, and lipid-lowering drug therapy on stroke severity, we aimed to evaluate whether previous physical activity was dose dependently associated to minor stroke (NIHSS 0-3) and to identify possible underlying factors. Among 362 consecutive patients, less severe stroke was related to weekly exercise duration prior to stroke (no exercise: 36.1%; <2 hours: 49.3%; 2-5 hours: 58.8%; >5 hours: 64.0%; P = 0.003). Only weak and moderate exercise practices were protective (weak: 50.0%; moderate: 79.3%; heavy: 22.2%; P < 0.0001). Such a beneficial effect was observed independently of age and was associated with a trend to a lower frequency of arterial hypertension, alcohol abuse, and a better metabolic profile. Besides other therapeutic approaches, physical activity may be a simple way to decrease cerebral ischemia severity.
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Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals. J Hypertens 2011; 29:553-64. [PMID: 21119532 DOI: 10.1097/hjh.0b013e3283418875] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) obesity is an independent risk factor for chronic kidney disease. This study was conducted to examine the effects of lifestyle interventions on renal parameters and putative metabolic, neuroadrenergic and hemodynamic mediators of renal injury. METHODS Untreated men and women (mean age 55 ± 1 years; BMI 32.7 ± 0.6 kg/m) without pre-existing renal dysfunction, who fulfilled MetS criteria were randomized to dietary weight loss (WL, n = 13), weight loss combined with aerobic exercise (WL + EX, n = 13), or no treatment (control, n = 12). Estimated glomerular filtration rate (eGFR), 24 h urinary albumin excretion, plasma renin activity (PRA), muscle sympathetic nerve activity (MSNA), baroreflex sensitivity (BRS), anthropometric, metabolic and fitness variables were measured at baseline and week 12. RESULTS Body weight decreased by -8.2 ± 0.8% in the WL and -10.7 ± 0.9% in the WL + EX groups (both P < 0.001). Fitness (maximal oxygen consumption) increased by 15 ± 5% and BRS by 5.5 ± 2.4 ms/mmHg in the WL + EX group only (P < 0.05). Serum creatinine decreased by -8.1 ± 4.8%, (WL, P = 0.016) and -14.9 ± 3.0% (WL + EX, P < 0.001). Estimated GFR increased commensurately but the increment was greater in the WL + EX group (P = 0.04). Albuminuria (P < 0.05) and MSNA (P < 0.001) decreased similarly in both groups, whereas PRA, high sensitivity C-reactive protein, uric acid and DBP decreased only in the WL + EX group (all P < 0.05). CONCLUSION Moderate weight loss in obese MetS patients is associated with a reduction in albuminuria and an improvement in eGFR which is augmented by exercise co-intervention.
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Carson V, Janssen I. Volume, patterns, and types of sedentary behavior and cardio-metabolic health in children and adolescents: a cross-sectional study. BMC Public Health 2011; 11:274. [PMID: 21542910 PMCID: PMC3112118 DOI: 10.1186/1471-2458-11-274] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/04/2011] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardio-metabolic risk factors are becoming more prevalent in children and adolescents. A lack of moderate-to-vigorous intensity physical activity (MVPA) is an established determinant of cardio-metabolic risk factors in children and adolescents. Less is known about the relationship between sedentary behavior and cardio-metabolic health. Therefore, the objective was to examine the independent associations between volume, patterns, and types of sedentary behavior with cardio-metabolic risk factors among children and adolescents. METHODS The results are based on 2527 children and adolescents (6-19 years old) from the 2003/04 and 2005/06 National Health and Nutrition Examination Surveys (NHANES). A cardio-metabolic risk score (CRS) was calculated based on age- and sex-adjusted waist circumference, systolic blood pressure, non-high-density lipoprotein cholesterol, and C-reactive protein values. Volume and patterns of sedentary behavior and moderate-to-vigorous physical activity (MVPA) were measured objectively using accelerometers. Types of sedentary behavior were measured by questionnaire. A series of logistic regression models were used to examine associations. RESULTS Volume and patterns of sedentary behavior were not predictors of high CRS after adjusting for MVPA and other confounders (P > 0.1). For types of sedentary behavior, high TV use, but not high computer use, was a predictor of high CRS after adjustment for MVPA and other confounders. Children and adolescents who watched ≥4 hours per day of TV were 2.53 (95% confidence interval: 1.45-4.42) times more likely to have high CRS than those who watched <1 hour per day. MVPA predicted high CRS after adjusting for all sedentary behavior measures and other confounders. After adjustment for waist circumference, MVPA also predicted high non-obesity CRS; however, the same relationship was not seen with TV use. CONCLUSION No association was observed between overall volume and patterns of sedentary behavior with cardio-metabolic risk factors in this large sample of children and adolescents. Conversely, high TV use and low MVPA were independently associated with cardio-metabolic risk factors. However, the association between high TV use and clustered cardio-metabolic risk factors appears to be mediated or confounded by obesity. Thus, TV and MVPA appear to be two separate behaviors that need to be targeted with different interventions and policies.
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Affiliation(s)
- Valerie Carson
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Zelle DM, Corpeleijn E, Stolk RP, de Greef MHG, Gans ROB, van der Heide JJH, Navis G, Bakker SJL. Low physical activity and risk of cardiovascular and all-cause mortality in renal transplant recipients. Clin J Am Soc Nephrol 2011; 6:898-905. [PMID: 21372213 DOI: 10.2215/cjn.03340410] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Low physical activity (PA) is a risk factor for mortality in the general population. This is largely unexplored in renal transplant recipients (RTRs). We studied whether PA is associated with cardiovascular and all-cause mortality in a prospective cohort of RTR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Between 2001 and 2003, 540 RTRs were studied (age, 51 ± 12 years; 54% male). PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). Cardiovascular and all-cause mortality were recorded until August 2007. RESULTS Independent of age, PA was inversely associated with metabolic syndrome, history of cardiovascular disease, fasting insulin, and triglyceride concentration, and positively associated with kidney function and 24-hour urinary creatinine excretion (i.e., muscle mass). During follow-up for 5.3 years (range, 4.7 to 5.7 years), 81 RTRs died, with 37 cardiovascular deaths. Cardiovascular mortality was 11.7, 7.2, and 1.7%, respectively, according to gender-stratified tertiles of PA (P=0.001). All-cause mortality was 24.4, 15.0, and 5.6% according to these tertiles (P<0.001). In Cox regression analyses, adjustment for potential confounders including history of cardiovascular disease, muscle mass, and traditional risk factors for cardiovascular disease did not materially change these associations. CONCLUSIONS Low PA is strongly associated with increased risk for cardiovascular and all-cause mortality in RTRs. Intervention studies are necessary to investigate whether PA improves long-term survival after renal transplantation.
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Affiliation(s)
- Dorien M Zelle
- Department of Nephrology, University Medical Center Groningen, Sector A, PO Box 30001, 9700 RB, Groningen, The Netherlands.
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