Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Social determinants of health

Racial and ethnic-related health disparities in the United States have been intensified by the greater burden of Coronavirus Disease 2019 (COVID-19) in racial and ethnic minority populations. Compared to non-Hispanic White individuals, non-Hispanic Black and Hispanic/Latinx individuals infected by COVID-19 are at greater risk for hospitalization, intensive care unit admission, and death. There are several factors that may contribute to disparities in COVID-19-related severity and outcomes in these minority populations, including the greater burden of cardiovascular and metabolic diseases as discussed in our companion review article. Social determinants of health are a critical, yet often overlooked, contributor to racial and ethnic-related health disparities in non-Hispanic Black and Hispanic/Latinx individuals relative to non-Hispanic White individuals. Thus, the purpose of this review is to focus on the essential role of social factors in contributing to health disparities in chronic diseases and COVID-19 outcomes in minority populations. Herein, we begin by focusing on structural racism as a social determinant of health at the societal level that contributes to health disparities through downstream social level (e.g., occupation and residential conditions) and individual level health behaviors (e.g., nutrition, physical activity, and sleep). Lastly, we conclude with a discussion of practical applications and recommendations for future research and public health efforts that seek to reduce health disparities and overall disease burden.

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multi-factorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.

Physical fitness, but not physical activity, is associated with mental health in apparently healthy young adults

BACKGROUND

The prevalence of mental health disorders is rising globally. Despite the popularity of exercise as a strategy to improve mental health in individuals with anxiety or depression, there is a paucity of literature on this topic in apparently healthy young individuals who are free from mental illness.

METHODS

We characterized relationships between actigraphy-derived physical activity levels and cardiorespiratory fitness (VO2max; via maximal graded exercise testing), with mental health assessed using psychometric questionnaires (POMS and PSS) in apparently healthy young adults (26±4.3yrs; 22 women and 26 men).

RESULTS

In women and men combined, relative VO2max (33.5±8.1 ml/kg/min) was associated (P<0.01) with POMS (r=-0.454) and PSS (r=-0.510) scores, and relationships between fitness and POMS were preserved (P<0.05) after controlling for body fat (27.2±9.9%). Additionally, VO2max was associated (P<0.05) with numerous POMS subcomponents (tension, anger, fatigue, depression, confusion; all=P<0.05). No relationships (P>0.05) were observed between physical activity profiles (sedentary time, light intensity time, moderate-vigorous intensity time, total steps, counts per day) with POMS or PSS scores, and only total steps was associated with relative VO2max (r=0.331; P=0.021). Relationships between relative VO2max and POMS scores were also observed in men (r=-0.407, P=0.039) and women (r=-0.490; P=0.021) individually, but VO2max and PSS relationships were exclusive to men (r=-0.516, P=0.007).

CONCLUSIONS

Independent of body composition, cardiorespiratory fitness, but not actigraphy-derived physical activity, is associated with mental health in apparently healthy young men and women. To maximize mental health benefits, exercise training interventions are advised to focus on eliciting improvements in cardiorespiratory fitness.

Effects of Low Doses of L-Carnitine Tartrate and Lipid Multi-Particulate Formulated Creatine Monohydrate on Muscle Protein Synthesis in Myoblasts and Bioavailability in Humans and Rodents

The primary objective of this study was to investigate the potential synergy between low doses of L-carnitine tartrate and creatine monohydrate to induce muscle protein synthesis and anabolic pathway activation in primary human myoblasts. In addition, the effects of Lipid multi-particulates (LMP) formulation on creatine stability and bioavailability were assessed in rodents and healthy human subjects. When used individually, L-carnitine tartrate at 50 µM and creatine monohydrate at 0.5 µM did not affect myoblast protein synthesis and signaling. However, when combined, they led to a significant increase in protein synthesis. Increased AKT and RPS6 phosphorylation were observed with 50 µM L-carnitine tartrate 5 µM creatine in combination in primary human myoblasts. When Wistar rats were administered creatine with LMP formulation at either 21 or 51 mg/kg, bioavailability was increased by 27% based on the increase in the area under the curve (AUC) at a 51 mg/kg dose compared to without LMP formulation. Tmax and Cmax were unchanged. Finally, in human subjects, a combination of LMP formulated L-carnitine at 500 mg (from L-carnitine tartrate) with LMP formulated creatine at 100, 200, or 500 mg revealed a significant and dose-dependent increase in plasma creatine concentrations. Serum total L-carnitine levels rose in a similar manner in the three combinations. These results suggest that a combination of low doses of L-carnitine tartrate and creatine monohydrate may lead to a significant and synergistic enhancement of muscle protein synthesis and activation of anabolic signaling. In addition, the LMP formulation of creatine improved its bioavailability. L-carnitine at 500 mg and LMP-formulated creatine at 200 or 500 mg may be useful for future clinical trials to evaluate the effects on muscle protein synthesis.

Arterial stiffness and carotid distensibility following acute formaldehyde exposure in female adults

Formaldehyde (FA) is a ubiquitous organic preservative used in several industries and represents an occupational health hazard. Short-term exposure to FA can increase oxidative stress and cause a decrease in conduit vessel function. These decrements in vascular function may extend to the arterial architecture, predisposing individuals to increased risk of cardiovascular disease. The purpose of this study was to investigate the impact of an acute 90-minute FA exposure period (259 ± 95 ppb) on indices of arterial architecture. Arterial stiffness and carotid distensibility as determined by central pressures, augmentation index (AIx), and carotid-femoral pulse wave velocity (cfPWV) (n=13F, 24 ± 1 year) as well as carotid stiffness and intima media thickness (IMT) (n = 9F, 23 ± 1 year) were assessed prior to (Pre-FA) and immediately following (Post-FA) exposure to FA in human cadaver dissection laboratories. Central pressures and cfPWV (Pre-FA: 5.2 ± 0.8 m.s^-1, Post-FA: 5.2 ± 1.1 m s^-1) were unchanged by acute FA exposure (p > 0.05). Carotid stiffness parameters and distension were unchanged by acute FA exposure (p > 0.05), although distensibility (Pre-FA: 33.9 ± 10.5[10-3*kPa^-1], Post-FA: 25.9 ± 5.5[10-3*kPa-1], p < 0.05), and IMT (Pre-FA: 0.42 ± 0.05 mm, Post-FA: 0.51 ± 0.11 mm, p < 0.05) decreased and increased, respectively. Individual Pre- to Post-FA changes in these markers of arterial architecture did not correlate with levels of FA exposure ([FA]: 20-473 ppb) (p > 0.05). Our group previously found vascular function decrements following acute FA exposure in human cadaver laboratories; here we found that carotid distensibility and intima media thickness are altered following FA exposure.

Impact of a Breathing Intervention on Engagement of Abdominal, Thoracic, and Subclavian Musculature during Exercise, a Randomized Trial

Background: Breathing technique may influence endurance exercise performance by reducing overall breathing work and delaying respiratory muscle fatigue. We investigated whether a two-month yoga-based breathing intervention could affect breathing characteristics during exercise. Methods: Forty-six endurance runners (age = 16.6 ± 1.2 years) were randomized to either a breathing intervention or control group. The contribution of abdominal, thoracic, and subclavian musculature to respiration and ventilation parameters during three different intensities on a cycle ergometer was assessed pre- and post-intervention. Results: Post-intervention, abdominal, thoracic, and subclavian ventilatory contributions were altered at 2 W·kg⁻¹ (27:23:50 to 31:28:41), 3 W·kg⁻¹ (26:22:52 to 28:31:41), and 4 W·kg⁻¹ (24:24:52 to 27:30:43), whereas minimal changes were observed in the control group. More specifically, a significant (p < 0.05) increase in abdominal contribution was observed at rest and during low intensity work (i.e., 2 and 3 W·kg⁻¹), and a decrease in respiratory rate and increase of tidal volume were observed in the experimental group. Conclusions: These data highlight an increased reliance on more efficient abdominal and thoracic musculature, and less recruitment of subclavian musculature, in young endurance athletes during exercise following a two-month yoga-based breathing intervention. More efficient ventilatory muscular recruitment may benefit endurance performance by reducing energy demand and thus optimize energy requirements for mechanical work.

Single muscle fibre contractile characteristics with lifelong endurance exercise

KEY POINTS

A hallmark trait of ageing skeletal muscle health is a reduction in size and function, which is most pronounced in the fast muscle fibres. We studied older men (74 ± 4 years) with a history of lifelong (>50 years) endurance exercise to examine potential benefits for slow and fast muscle fibre size and contractile function. Lifelong endurance exercisers had slow muscle fibres that were larger, stronger, faster and more powerful than young exercisers (25 ± 1 years) and age-matched non-exercisers (75 ± 2 years). Limited benefits with lifelong endurance exercise were noted in the fast muscle fibres. These findings suggest that additional exercise modalities (e.g. resistance exercise) or other therapeutic interventions are needed to target fast muscle fibres with age.

ABSTRACT

We investigated single muscle fibre size and contractile function among three groups of men: lifelong exercisers (LLE) (n = 21, 74 ± 4 years), old healthy non-exercisers (OH) (n = 10, 75 ± 2 years) and young exercisers (YE) (n = 10, 25 ± 1 years). On average, LLE had exercised ∼5 days week^-1 for ∼7 h week^-1 over the past 53 ± 6 years. LLE were subdivided based on lifelong exercise intensity into performance (LLE-P) (n = 14) and fitness (LLE-F) (n = 7). Muscle biopsies (vastus lateralis) were examined for myosin heavy chain (MHC) slow (MHC I) and fast (MHC IIa) fibre size and function (strength, speed, power). LLE MHC I size (7624 ± 2765 μm² ) was 25-40% larger (P < 0.001) than YE (6106 ± 1710 μm² ) and OH (5476 ± 2467 μm² ). LLE MHC I fibres were ∼20% stronger, ∼10% faster and ∼30% more powerful than YE and OH (P < 0.05). By contrast, LLE MHC IIa size (6466 ± 2659 μm² ) was similar to OH (6237 ± 2525 μm² ; P = 0.854), with both groups ∼20% smaller (P < 0.001) than YE (7860 ± 1930 μm² ). MHC IIa contractile function was variable across groups, with a hierarchical pattern (OH > LLE > YE; P < 0.05) in normalized power among OH (16.7 ± 6.4 W L^-1 ), LLE (13.9 ± 4.5 W L^-1 ) and YE (12.4 ± 3.5 W L^-1 ). The LLE-P and LLE-F had similar single fibre profiles with MHC I power driven by speed (LLE-P) or force (LLE-F), suggesting exercise intensity impacted slow muscle fibre mechanics. These data suggest that lifelong endurance exercise benefited slow muscle fibre size and function. Comparable fast fibre characteristics between LLE and OH, regardless of training intensity, suggest other exercise modes (e.g. resistance training) or myotherapeutics may be necessary to preserve fast muscle fibre size and performance with age.

Perceived Pain Responses to Foam Rolling Associate with Basal Heart Rate Variability

BACKGROUND

Foam rolling (FR) is a self-myofascial release technique with unclear effects on autonomic functioning, indexed by heart rate variability (HRV). FR can be perceived as painful or relaxing, which may explain interindividual HRV responses.

PURPOSE

To determine if acute FR alters resting HRV. A secondary aim was to determine if perceived pain during FR would predict HRV responses.

SETTING

Academic institution.

METHODS

In a randomized, crossover design, healthy adults (50% female) performed total body FR or control on separate days. Perceived pain ratings were obtained following FR of each muscle group and summed to generate an overall perceived pain rating. Seated measures of the mean RR interval and the natural logarithm of the root-mean square of successive RR interval differences (LnRMSSD, a parasympathetic HRV index) were obtained at 5-10 min pre-, 5-10 min post-, and 25-30 min post-FR.

RESULTS

No effects were observed for RR interval (p = .105-.561) or LnRMSSD (p = .110-.129). All effect sizes ranged from trivial-small (0.00-0.26). Changes in RR interval (r = 0.220-0.228, p = .433-.488) and LnRMSSD (r = 0.013-0.256, p = .376-.964) were not associated with pain scale sum. Baseline LnRMSSD was associated with pain scale sum (r = -0.663; p = .001).

CONCLUSION

FR did not systematically alter HRV, nor did perceived pain ratings predict HRV responses. Those with lower pre-FR HRV reported higher perceived pain during FR. Basal cardiac autonomic activity may, therefore, influence pain sensitivity to FR in healthy adults.

Cardiac-autonomic and hemodynamic responses to a hypertonic, sugar-sweetened sports beverage in physically active men

Hydration practices may confound heart rate variability (HRV) measurements when collected in the pre-training period. We aimed to determine the effects of ingesting a hypertonic, sugar-sweetened sports beverage on HRV and hemodynamic parameters in physically active young men. Fifteen subjects consumed 591 mL of Gatorade (6% carbohydrate, ∼330 mOsmol/kg), 591 mL water, or 10 mL water (control) in random order on separate days following overnight fasting. HRV and hemodynamics were evaluated in 5-min windows immediately before (T1) and 5-10 min (T2), 25-30 min (T3), 40-45 min (T4), and 55-60 min (T5) post-drinking. Root-mean square of successive differences and the standard deviation of normal RR intervals increased post-water intake at all time-points relative to T1 (P < 0.05). No increases were observed post-Gatorade intake, though small effect sizes were noted at T2 and T3 (P > 0.05, ES = 0.27-0.32). Systemic vascular resistance increased at T2 post-Gatorade intake and at T2 and T3 post-water intake (P < 0.05). No interactions were observed for blood pressure measures, stroke volume, or cardiac output. Gatorade does not evoke cardiovascular adjustments to the same magnitude as water. Practitioners should wait at least 45 min to record HRV post-Gatorade intake and >60 min post-water intake. Novelty: Equal volumes of cold water and Gatorade produce inequivalent cardiac-autonomic and hemodynamic responses. HRV responses of greater amplitude and duration were observed following intake of water versus Gatorade. Failure to account for recent fluid intake may result in misinterpretation of autonomic status.

Superior Adaptations in Adolescent Runners Using Heart Rate Variability (HRV)-Guided Training at Altitude

We evaluated the efficacy of heart rate variability (HRV)-guided training in adolescent athletes during a 2-week, high altitude (≈1900 m) training camp. Sixteen middle- and long-distance runners (4 female/12 male, 16.9 ± 1.0 years, 65.44 ± 4.03 mL·kg-1·min-1) were divided into 2 matched groups, both of which received the same training plan, but one of which acquired postwaking HRV values that were used to tailor the training prescription. During the camp, seven athletes in the HRV-guided group combined for a total of 32 training adjustments, whereas there were only 3 runners combined for 14 total training adjustments in the control group. A significant group by time interaction (p < 0.001) for VO2max was driven by VO2max improvements in the HRV group (+2.8 mL·kg-1·min-1, +4.27%; pBonf = 0.002) that were not observed in the control condition (+0.8 mL·kg-1·min-1, +1.26%; pBonf = 0.643). After returning from the camp, all athletes in the HRV group set a personal best, and six out of eight achieved their best positions in the National Championship, whereas only 75% of athletes in the control group set a personal best and five out of eight achieved their best positions in the National Championship. These data provide evidence in support of HRV-guided training as a way to optimize training prescriptions in adolescent athletes.

Evidence for the Contribution of Gut Microbiota to Age-Related Anabolic Resistance

Globally, people 65 years of age and older are the fastest growing segment of the population. Physiological manifestations of the aging process include undesirable changes in body composition, declines in cardiorespiratory fitness, and reductions in skeletal muscle size and function (i.e., sarcopenia) that are independently associated with mortality. Decrements in muscle protein synthetic responses to anabolic stimuli (i.e., anabolic resistance), such as protein feeding or physical activity, are highly characteristic of the aging skeletal muscle phenotype and play a fundamental role in the development of sarcopenia. A more definitive understanding of the mechanisms underlying this age-associated reduction in anabolic responsiveness will help to guide promyogenic and function promoting therapies. Recent studies have provided evidence in support of a bidirectional gut-muscle axis with implications for aging muscle health. This review will examine how age-related changes in gut microbiota composition may impact anabolic response to protein feeding through adverse changes in protein digestion and amino acid absorption, circulating amino acid availability, anabolic hormone production and responsiveness, and intramuscular anabolic signaling. We conclude by reviewing literature describing lifestyle habits suspected to contribute to age-related changes in the microbiome with the goal of identifying evidence-informed strategies to preserve microbial homeostasis, anabolic sensitivity, and skeletal muscle with advancing age.

Bone Mineral Density and Muscle Mass in Masters Olympic Weightlifters and Runners

The authors examined the musculoskeletal implications of delayed exercise adoption in two distinct cohorts of masters athletes with ∼10 years of training experience: Olympic weightlifters (OWLs) and distance runners (RUNs). Total body and regional bone mineral density (BMD), and dual-energy X-ray absorptiometry-derived lean mass were compared in 51 OWLs and 43 RUNs. Multiple linear regression analyses were conducted on BMD and lean mass with the exercise group (i.e., OWLs vs. RUNs), age, sex, and years of experience as independent variables. Age was associated (p < .05) with less femoral (β = -0.25) and lumbar (β = -0.27) BMD. Total body (β = 0.23), lumbar (β = 0.25), and radial (β = 0.36) BMD were greater (p < .05) in OWLs versus RUNs. Lean mass was greater in OWLs versus RUNs (β = 0.29, p < .01), but did not relate to total body BMD (r = .15; p = .08). Greater total and regional BMD and lean mass in OWLs compared with RUNs may reduce risk for developing osteoporosis and/or sarcopenia and associated downstream health outcomes.

Rapid gut microbiome changes in a world-class ultramarathon runner

The human gut microbiome is a dynamic ecosystem with prolific health connotations. Physical activity is emerging as a potent regulator of human microbiome composition. This study examined changes in the gut microbiome of a world‐class ultramarathon runner before and after competing in the Western States Endurance Run (WSER), a 163 km mountain footrace. Anthropometrics and body composition were assessed and the ultramarathoner's submaximal and maximal performance profiles were evaluated. Gut microbiome analyses were performed at four time‐points: 21 weeks and 2 weeks before and 2 hours and 10 days after WSER. Aerobic power (VO₂max) was 4.24 L/min (66.7 ml kg⁻¹ min⁻¹), and running economy (51.1 ml kg⁻¹ min⁻¹ at 268 m/min) and lactate threshold (~83% VO₂max) values were comparable to that of highly trained distance runners. Two hours post‐race, considerable changes in the ultrarunners’ gut microbiome were observed. Alpha diversity (Shannon Diversity Index) increased from 2.73 to 2.80 and phylum‐level bacterial composition (Firmicutes/Bacteroidetes ratio) rose from 4.4 to 14.2. Underlying these macro‐level microbial alterations were demonstrable increases in select bacterial genera such as Veillonella (+14,229%) and Streptococcus (+438%) concomitant with reductions in Alloprevotella (−79%) and Subdolingranulum (−50%). To our knowledge, this case study shows the most rapid and pronounced shifts in human gut microbiome composition after acute exercise in the human literature. These findings provide yet another example of how exercise can be a powerful modulator of human health.

Application of Cut-Points for Low Muscle Strength and Lean Mass in Mobility-Limited Older Adults

BACKGROUND

The Sarcopenia Definitions and Outcomes Consortium (SDOC) is a collaborative initiative seeking to develop and evaluate cut-points for low muscle strength and lean mass that predict an increased risk for slowness (usual walking speed <.8 m/s) among older adults.

OBJECTIVES

The goal of the present study was to provide clinicians and researchers with an understanding of the diagnostic implications of using SDOC variables and cut-points in mobility-limited older adults. Using data from older individuals with specific conditions that render them at increased risk for mobility limitation, we evaluated the performance characteristics (ie, sensitivity and specificity) of five putative sarcopenia parameters and then compared these values with previously recommended diagnostic criteria for sarcopenia.

DESIGN

Retrospective analysis of six randomized controlled trials enriched in persons at risk for mobility limitation.

SETTING

National and international geriatric clinical research centers.

PARTICIPANTS

A total of 925 mobility-limited older adults (≥55 years of age; 58% women) were included in the analysis.

MEASUREMENTS

The prevalence of low muscle strength and lean mass were assessed using five candidate metrics discriminative of slowness. Analyses of sensitivity and specificity were used to compare muscle weakness criteria with published diagnostics for sarcopenia.

RESULTS

Odds ratios (ORs) supported maximal grip strength (Grip max <35.5 and 20.0 in men and women, respectively) as the most discriminative of slowness in both men and women (OR = 3.66 and 3.53, respectively). More men (58%) than women (30%) fell below sex-specific maximal grip cut-points. When applying previously recommended sarcopenia component definitions in our population, we found that fewer individuals met those criteria (range = 6%-32%).

CONCLUSION

A greater number of individuals fall below SDOC Grip max cut-points compared with previous recommendations. Clinicians and researchers working with older adults may consider these thresholds as an inclusive means to identify candidates for low-risk lifestyle promyogenic and function-promoting therapies. J Am Geriatr Soc 68:1445-1453, 2020.

Physiological Predictors of Performance on the CrossFit "Murph" Challenge

We examined physiological predictors of performance on the CrossFit Murph challenge (1-mile run, 100 pullups, 200 pushups, 300 air squats, 1-mile run). Male CrossFit athletes (n = 11, 27 ± 3 years) performed a battery of physical assessments including: (1) body composition, (2) upper and lower body strength, (3) upper body endurance, (4) anaerobic power, and (5) maximal oxygen consumption. No less than 72 h later, participants completed the Murph challenge, heart rate was monitored throughout, and blood lactate was obtained pre-post. Correlations between physiological parameters and total Murph time, and Murph subcomponents, were assessed using Pearson's correlations. Murph completion time was 43.43 ± 4.63 min, and maximum and average heart rate values were 185.63 ± 7.64 bpm and 168.81 ± 6.41 bpm, respectively, and post-Murph blood lactate was 10.01 ± 3.04 mmol/L. Body fat percentage was the only physiological parameter significantly related to total Murph time (r = 0.718; p = 0.013). Total lift time (25.49 ± 3.65 min) was more strongly related (r = 0.88) to Murph time than total run time (17.60 ± 1.97 min; r = 0.65). Greater relative anaerobic power (r = -0.634) and less anaerobic fatigue (r = 0.649) were related to total run time (p < 0.05). Individuals wanting to enhance overall Murph performance are advised to focus on minimizing body fat percentage and improving lift performance. Meanwhile, performance on the run subcomponent may be optimized through improvements in anaerobic power.