Effects of physical activity on exercise tests and respiratory function

The association between leisure-time physical activity and lung function in older adults: The English longitudinal study of ageing

The longitudinal association between physical activity and lung function is unclear. Therefore, we examined said association over eight years. This study included data from 2966 participants in English Longitudinal Study of Ageing (63±7years [mean±SD]), a prospective study of initially healthy, community dwelling adults. Physical activity was assessed using an interview and lung function using a spirometer at baseline (2004-5) and follow-up (2012-13). General linear regression was used to assess associations between activity and lung function. Logistic regression was used to assess the odds of new cases of abnormal lung function. Some 14% of participants were defined as physically inactive at baseline, 50% were classified into the moderate group, and 36% into the vigorous group. In comparison with remaining inactive at follow-up, remaining active was positively associated with forced vital capacity (FVC) (β=0.09, 95% confidence interval [CI]: 0.01, 0.17; p=0.02) and forced expiratory volume in one second (FEV-1) (β=0.09, 95% CI: 0.02, 0.15; p=0.01) after adjustment for baseline lung function score and other covariates. Using the fifth centile to define the lower limit of normal (that is, -1.64 z scores), there were lower odds of incident abnormal lung function in participants who remained physically active compared to those who remained inactive (FVC odds ratio=0.31, 95% CI: 0.17, 0.55. FEV-1 odds ratio=0.43, 95% CI: 0.26, 0.72). Similar associations were observed in those who became active. This study suggests that remaining physically active or becoming active in older age is positively associated with lung function and reduced odds of abnormal lung function.

The training type influence on male elite athletes' ventilatory function

Background/aim

To assess and compare measured ventilatory volumes (forced expiratory volume in 1 s (FEV₁), peak expirium flow (PEF) and maximal voluntary ventilation (MVV)), ventilatory function capacities (forced vital capacity (FVC) and vital capacity (VC)) and FEV₁/VC ratio in a sample of power and endurance elite athletes and their age-matched and sex-matched sedentary control group.

Methods

A cross-sectional study was applied on male elite athletes (n=470) who were classified according to the type of the predominantly performed exercise in the following way: group 1: endurance group (EG=270), group 2: power athletes group (SG=200) and group 3: sedentary control group (CG=100). The lung VC, FVC, FEV₁, FEV₁/FVC ratio, PEF and MVV were measured in all of the observed subjects, who were also classified with regard to body mass index (BMI) and the percentage of the body fat (BF%).

Results

The CG had the highest BF% value, while the endurance group had the lowest BMI and BF% value, which is significantly different from the other two groups (p<0.05). The observed values of VC, FVC and FEV₁ in the EG were significantly higher than those from the other two groups (p<0.05). There were no differences concerning the observed FEV₁/FVC ratio.

Conclusions

A continued endurance physical activity leads to adaptive changes in spirometric parameters (VC, FVC and FEV₁), highlighting the fact that there is a need for specific consideration of different respiratory ‘pattern’ development in different types of sport, which also has to be further evaluated.

The Effects of Ramadan Fasting on the Spirometric Data of Healthy Adult Males

The few studies carried out on the effects of Ramadan fasting (RF) on spirometric values present contradictory conclusions. This study aimed at assessing whether RF affects healthy adults' spirometric values. Twenty-nine nonsmoking healthy males ( M ± standard error of mean [ SEM] of age: 27 ± 1 years) who fasted during Ramadan (June 29-July 28, 2014) volunteered to the study. Three periods (before-Ramadan [June 23-25], mid-Ramadan [July 14-16] and after-Ramadan [August 11-14]) were selected for spirometry measurements that were consistently performed 5.5 to 3.5 hours (between 15:00 and 17:00 hours) before fasting break. Assessment sessions comprised following: weight (kg), forced vital capacity (FVC), first second expiratory volume (FEV₁), FEV₁/FVC, peak expiratory flow (PEF), maximal mid expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEF _x%). Spirometric data were expressed in percentages of reference values. Results were analyzed by applying repeated measures analysis of variance. The M ± SEM of weight (before-R: 81.6 ± 2.8 kg, mid-R: 80.8 ± 2.9 kg, after-R: 81.2 ± 2.9 kg), FEV₁ (before-R: 99 ± 2%, mid-R: 98 ± 2%, after-R: 98 ± 2%), FVC (before-R: 103 ± 2%, mid-R: 101 ± 2%, after-R: 101 ± 2%), PEF (before-R: 112 ± 3%, mid-R: 113 ± 2%, after-R: 114 ± 3%), MMEF (before-R: 83 ± 3%, mid-R: 83 ± 3%, after-R: 82 ± 3%), FEF_25% (before-R: 90 ± 5%, mid-R: 89 ± 6%, after-R: 87 ± 6%), FEF_50% (before-R: 94 ± 4%, mid-R: 91 ± 4%, after-R: 93 ± 3%), and FEF_75% (before-R: 108 ± 3%, mid-R: 111 ± 2%, after-R:111 ± 3%) were not significantly influenced by RF. To conclude, RF did not bring about any significant changes in the spirometric values of nonsmoking healthy adult males.

Association between physical activity in daily life and pulmonary function in adult smokers

Objective:

To determine whether the level of physical activity in daily life (PADL) is associated with pulmonary function in adult smokers.

Methods:

We selected 62 adult smokers from among the participants of an epidemiological study conducted in the city of Santos, Brazil. The subjects underwent forced spirometry for pulmonary function assessment. The level of PADL was assessed by the International Physical Activity Questionnaire and triaxial accelerometry, the device being used for seven days. The minimum level of PADL, in terms of quantity and intensity, was defined as 150 min/week of moderate to vigorous physical activity. Correlations between the studied variables were tested with Pearson's or Spearman's correlation coefficient, depending on the distribution of the variables. We used linear multiple regression in order to analyze the influence of PADL on the spirometric variables. The level of significance was set at 5%.

Results:

Evaluating all predictors, corrected for confounding factors, and using pulmonary function data as outcome variables, we found no significant associations between physical inactivity, as determined by accelerometry, and spirometric indices. The values for FVC were lower among the participants with arterial hypertension, and FEV₁/FVC ratios were lower among those with diabetes mellitus. Obese participants and those with dyslipidemia presented with lower values for FVC and FEV₁.

Conclusions:

Our results suggest that there is no consistent association between physical inactivity and pulmonary function in adult smokers. Smoking history should be given special attention in COPD prevention strategies, as should cardiovascular and metabolic comorbidities.

Brief communication (Original). The effect of physical activity on 6-minute walked distance among niqab wearing healthy Saudi women

Background: Wearing a face veil (niqab) was found to have a negative effect on the ventilatory function of Saudi adult women, which may challenge their functional exercise capacity.

Objectives: To investigate the effect of physical activity on a 6-minute walked distance (6-MWD) among young adult niqab-wearing healthy Saudi women.

Materials and Methods: Forty healthy young Saudi women were recruited for this study. The study participants (aged 22.8 ± 2.5 years) were selected from students and administrative staff at King Saud University. They were normotensive, nonsmokers, and of normal or mildly overweight. They were divided into 2 groups on basis of niqab wearing. A 6- minute walk test was implemented as measure of the participant’s functional exercise capacity. Their physical activity level was expressed as low, moderate, or high levels using the International Physical Activity Questionnaire-Short Form. Comparisons between the basal physiological characters of the 2 groups, 6-MWD, and physical activity level were conducted. A two-way independent ANOVA was used to study the interaction of niqab wearing and the physical activity level on the 6-MWD for niqab wearing women.

Results: Women in the niqab wearing group had a significantly higher physical activity level and longer 6-MWD than those in the niqab nonwearing group (370.7 ± 62.95 and 510.0 ± 81.75 m (mean ± SD) respectively).

Conclusion: A physically active lifestyle improves and preserves the functional exercise capacity reflected by longer 6-MWD among the physically active niqab-wearing Saudi adult healthy women compared with less active women who did not wear the niqab.

Acute respiratory response to traffic-related air pollution during physical activity performance

BACKGROUND

Physical activity (PA) has beneficial, whereas exposure to traffic related air pollution (TRAP) has adverse, respiratory effects. Few studies, however, have examined if the acute effects of TRAP upon respiratory outcomes are modified depending on the level of PA.

OBJECTIVES

The aim of our study was to disentangle acute effects of TRAP and PA upon respiratory outcomes and assess the impact of participants TRAP pre-exposure.

METHODS

We conducted a real-world crossover study with repeated measures of 30 healthy adults. Participants completed four 2-h exposure scenarios that included either rest or intermittent exercise in high- and low-traffic environments. Measures of respiratory function were collected at three time points. Pre-exposure to TRAP was ascertained from land-use-modeled address-attributed values. Mixed-effects models were used to estimate the impact of TRAP and PA on respiratory measures as well as potential effect modifications.

RESULTS

We found that PA was associated with a statistically significant increases of FEV₁ (48.5mL, p=0.02), FEV₁/FVC (0.64%, p=0.005) and FEF_25-75% (97.8mL, p=0.02). An increase in exposure to one unit (1μg/m³) of PM_coarse was associated with a decrease in FEV₁ (-1.31mL, p=0.02) and FVC (-1.71mL, p=0.01), respectively. On the other hand, for an otherwise equivalent exposure an increase of PA by one unit (1%Heart rate max) was found to reduce the immediate negative effects of particulate matter (PM) upon PEF (PM_2.5, 0.02L/min, p=0.047; PM₁₀, 0.02L/min p=0.02; PM_coarse, 0.03L/min, p=0.02) and the several hours delayed negative effects of PM upon FVC (PM_coarse, 0.11mL, p=0.02). The negative impact of exposure to TRAP constituents on FEV₁/FVC and PEF was attenuated in those participants with higher TRAP pre-exposure levels.

CONCLUSIONS

Our results suggest that associations between various pollutant exposures and respiratory measures are modified by the level of PA during exposure and TRAP pre-exposure of participants.

Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults

Objective

: To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL), as well as with cardiovascular disease (CVD) risk factors, in asymptomatic adults.

Methods

: A total of 374 participants (mean age, 41 ± 14 years) underwent spirometry, which included the determination of FVC and FEV₁. A restrictive pattern on spirometry was defined as an FEV₁/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer.

Results

: A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness), the following variables retained significance (OR; 95% CI) as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8), smoking (11.6; 1.56-87.5), physical inactivity (8.1; 1.43-46.4), larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71); and dyslipidemia (1.89; 1.12-1.98).

Conclusions

: A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.

Obesity and Smoking: can we Kill Two Birds with one Tax?

The debate on tobacco and fat taxes often treats smoking and eating as independent behaviors. However, the available evidence shows that they are interdependent, which implies that policies against smoking or obesity may have larger scope than expected. To address this issue, we propose a dynamic rational model where eating, smoking, and physical exercise are simultaneous choices that jointly affect body weight and addiction to smoking. Focusing on direct and cross-price effects, we study the impact of tobacco and food taxes, and we show that in both cases a single policy tool can reduce both smoking and body weight. Copyright © 2015 John Wiley & Sons, Ltd.

Physical activity and lung function decline in adults with asthma: The HUNT Study

BACKGROUND AND OBJECTIVE

People with asthma may seek advice about physical activity. However, the benefits of leisure time physical activity on lung function are unclear. We investigated the association between leisure time physical activity and lung function decline in adults with asthma.

METHODS

In a population-based cohort study in Norway, we used multiple linear regressions to estimate the annual mean decline in lung function (and 95% CI) in 1329 people with asthma over a mean follow-up of 11.6 years. The durations of light and hard physical activity per week in the last year were collected by questionnaire. Inactive participants did not report any light or hard activity, while active participants reported light or hard activity.

RESULTS

The mean decline in forced expiratory volume in 1 s (FEV₁ ) was 37 mL/year among inactive participants and 32 mL/year in active participants (difference: -5 mL/year (95% CI: -13 to 3)). The mean decline in forced vital capacity (FVC) was 33 mL/year among inactive participants and 31 mL/year in active participants (difference: -2 mL/year (95% CI: -11 to 7)). The mean decline in FEV₁ /FVC ratio was 0.36%/year among inactive participants and 0.22%/year in active participants (difference: -0.14%/year (95% CI: -0.27 to -0.01)). The mean decline in peak expiratory flow (PEF) was 14 mL/year among the inactive participants and 10 mL/year in active participants (difference: -4 mL/year (95% CI: -9 to 1)).

CONCLUSION

We observed slightly less decline in lung function in physically active than inactive participants with asthma, particularly for FEV₁ , FEV₁ /FVC ratio and PEF.

Sport-specific influences on respiratory patterns in elite athletes

OBJECTIVE:

To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows.

METHODS:

This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 ± 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry).

RESULTS:

Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV₁, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV₁ (r = −0.386; p < 0.001).

CONCLUSIONS:

Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

Does smoking influence the physical activity and lung cancer relation? A systematic review and meta-analysis

Research suggests an inverse association between physical activity and lung cancer. However, whether the relation is modified by degree of smoking adjustment has not been summarized. We conducted a meta-analysis of physical activity and lung cancer focusing on evaluating whether smoking status and the degree of smoking adjustment influenced the association. Comparing high versus low physical activity levels from 25 observational studies yielded a lung cancer summary relative risk (RR) of 0.79 [95 % confidence interval (CI) = 0.72-0.87], with RRs of 0.87 (95 % CI = 0.80-0.94) for cohort studies and 0.57 (95 % CI = 0.46-0.71) for case-control studies. In further analyses restricted to cohort studies, physical activity was inversely related to lung cancer among former smokers (RR = 0.68, 95 % CI = 0.51-0.90) and current smokers (RR = 0.80, 95 % CI = 0.70-0.90), whereas the association was null among never smokers (RR = 1.05, 95 % CI = 0.78-1.40, p interaction = 0.26). The degree of smoking adjustment did not modify the association (p interaction = 0.73). Physical activity was unrelated to lung cancer among never smokers but it was inversely associated with lung cancer among former and current smokers. Although the physical activity and lung cancer relation was not modified by smoking status or degree of smoking adjustment, residual confounding by smoking remains a possible explanation for the relations observed.

Body Mass Index, the Most Widely Used But Also Widely Criticized Index: Would a Criterion Standard Measure of Total Body Fat Be a Better Predictor of Cardiovascular Disease Mortality?

OBJECTIVES

To examine whether an accurate measure (using a criterion standard method) of total body fat would be a better predictor of cardiovascular disease (CVD) mortality than body mass index (BMI).

PARTICIPANTS AND METHODS

A total of 60,335 participants were examined between January 1, 1979, and December 31, 2003, and then followed-up for a mean follow-up period of 15.2 years. Body mass index was estimated using standard procedures. Body composition indices (ie, body fat percentage [BF%], fat mass index [FMI], fat-free mass [FFM], and FFM index [FFMI]) were derived from either skinfold thicknesses or hydrostatic weighing. For exact comparisons, the indices studied were categorized identically using sex-specific percentiles.

RESULTS

Compared with a medium BMI, a very high BMI was associated with a hazard ratio (HR) of 2.7 (95% CI, 2.1-3.3) for CVD mortality, which was a stronger association than for BF% or FMI (ie, HR, 1.6; 95% CI, 1.3-1.9 and HR, 2.2; 95% CI, 1.8-2.7, respectively). Compared with a medium FFMI, a very high FFMI was associated with an HR of 2.2 (95% CI, 1.7-2.7) for CVD mortality, with these estimates being markedly smaller for FFM (ie, HR, 1.2; 95% CI, 0.9-1.6). When the analyses were restricted only to the sample assessed with hydrostatic weighing (N=29,959, 51.7%), the results were similar, with even slightly larger differences in favor of BMI (ie, HR, 3.0; 95% CI, 2.2-4.0) compared with BF% and FMI (ie, HR, 1.5; 95% CI, 1.2-1.9 and HR, 2.1; 95% CI, 1.6-2.7, respectively). We estimated Harrell's c-index as an indicator of discriminating/predictive ability of these models and observed that the c-index for models including BMI was significantly higher than that for models including BF% or FMI (P<.005 for all).

CONCLUSION

The simple and inexpensive measure of BMI can be as clinically important as, or even more than, total adiposity measures assessed using accurate, complex, and expensive methods. Physiological explanations for these findings are discussed.

Correlation between heart rate variability and pulmonary function adjusted by confounding factors in healthy adults

The autonomic nervous system maintains homeostasis, which is the state of balance in the body. That balance can be determined simply and noninvasively by evaluating heart rate variability (HRV). However, independently of autonomic control of the heart, HRV can be influenced by other factors, such as respiratory parameters. Little is known about the relationship between HRV and spirometric indices. In this study, our objective was to determine whether HRV correlates with spirometric indices in adults without cardiopulmonary disease, considering the main confounders (e.g., smoking and physical inactivity). In a sample of 119 asymptomatic adults (age 20-80 years), we evaluated forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). We evaluated resting HRV indices within a 5-min window in the middle of a 10-min recording period, thereafter analyzing time and frequency domains. To evaluate daily physical activity, we instructed participants to use a triaxial accelerometer for 7 days. Physical inactivity was defined as <150 min/week of moderate to intense physical activity. We found that FVC and FEV1, respectively, correlated significantly with the following aspects of the RR interval: standard deviation of the RR intervals (r =0.31 and 0.35), low-frequency component (r =0.38 and 0.40), and Poincaré plot SD2 (r =0.34 and 0.36). Multivariate regression analysis, adjusted for age, sex, smoking, physical inactivity, and cardiovascular risk, identified the SD2 and dyslipidemia as independent predictors of FVC and FEV1 (R2=0.125 and 0.180, respectively, for both). We conclude that pulmonary function is influenced by autonomic control of cardiovascular function, independently of the main confounders.

Effect of Eight-Week Aerobic, Resistive, and Interval Exercise Routines on Respiratory Parameters in Non-Athlete Women

BACKGROUND

There are not many studies about the effects of physical activity on pulmonary function in normal population. However, it seems that strengthening and persevering respiratory muscles is an effective technique for improving pulmonary function.

OBJECTIVE

The purpose of this study was to evaluate and compare the effects of eight-week aerobic, resistance, and interval exercise routines on respiratory parameters in non-athlete women.

MATERIALS AND METHODS

Thirty-six non-athlete women between 18-25 years old participated in this prospective quasi-experimental trial. The subjects were randomly divided into three groups (aerobic, resistance and interval exercise, 12 in each group). Each group exercised three times a week for a total of eight weeks (24 sessions in total). Pulmonary function tests (PFT), including tidal volume (VT), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), inspiratory capacity (IC), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first seconds (FEV₁), the ratio of FEV₁/FVC, peak inspiratory flow (PIF), and forced expiratory flow (FEF 25-75%) were recorded before and after the implementation of the exercise program for all participants. Data were analyzed using paired t-test and one-way ANOVA.

RESULTS

The mean age of participants was 20.17 ± 2.13. The results of the paired T-test indicated that VC significantly increased in the group assigned to aerobic exercise (P = 0.028), while IC (P = 0.012) and PIF (P = 0.019) significantly increased in the group assigned to interval training.

CONCLUSION

Our results showed that interval and aerobic exercise routines could improve pulmonary functions and aerobic and interval training can be used to increase VC, IC, PIF, in non-athlete women.

Effects of Aerobic Exercise on the Pulmonary Functions, Respiratory Symptoms and Psychological Status of People Living With HIV

BACKGROUND

Pulmonary complications, respiratory symptoms and depression are common occurrences which contribute to the morbidity and mortality seen in individuals living with HIV/AIDS. This study investigated the effect of aerobic exercise on the pulmonary functions, respiratory symptoms and psychological status of people living with HIV.

METHODS

This study was conducted in Lagos, Nigeria from October 2014 to May 2015. Forty eligible individuals with HIV aged 18 yr and above participated, of which 33 cooperated to the end. They were recruited from the HIV/AIDS Prevention and Intervention Initiative (APIN) Clinic, Lagos University Teaching Hospital, Nigeria and were randomly assigned to either the study or the control group. The study group received aerobic exercise training three times a week for six weeks and counselling while the control group received only counselling. Pulmonary functions, respiratory symptoms and psychological status were evaluated at baseline and at six weeks. Inferential statistics of paired and independent t-test were used to analyse the data.

RESULTS

Comparison of mean changes in the pulmonary variables of the study group with those of the control group showed significant differences in all but in the respiratory rate (RR) - [Forced Expiratory Volume in one second: P=0.001, Forced Vital Capacity: P=0.001, Peak Expiratory Flow: P=0.001]. There were also significant differences between the mean changes in respiratory symptoms (P=0.001) and depressive symptoms (P=0.001) of study group and those of the control group.

CONCLUSIONS

Aerobic exercise training significantly improved pulmonary functions as well as significantly reduced respiratory and depressive symptoms in people living with HIV.

Effect of low-intensity continuous training on lung function and cardiorespiratory fitness in both cigarette and hookah smokers

BACKGROUND

The decline in cardiorespiratory fitness and lung function was higher in smokers. Training method could mitigate some of the negative consequences of smoking among smokers unable or unwilling to quit.

OBJECTIVE

To examine the effects of continuous training on lungs functional capability and cardiorespiratory fitness in smokers.

METHODS

Fifteen cigarette smokers, 14 hookah smokers, and 14 nonsmokers were assigned to low-intensity continuous training (20-30 minutes of running at 40% of maximum oxygen uptake (O2max)). Lung function and cardiorespiratory fitness parameters were determined using respectively spirometer and treadmill maximal exercise test.

RESULTS

Continuous training improved forced expiratory volume in one second (FEV1) and forced expiratory flow at 50% of FVC (FEF50 %) in all participants, smokers and nonsmokers (p < 0.05). In contrast, forced vital capacity (FVC) improvement was significant only among cigarette smokers (CS) (+1.7±2.21%, p < 0.01) and hookah smokers (HS) (+1.3±1.7 %, p < 0.05). Likewise, an improvement in cardiorespiratory fitness in both smokers groups without significant changes in diastolic blood pressure (DBP) for CS group and in velocity at maximum oxygen uptake (vO2max) for HS group.

CONCLUSION

The low-intensity continuous training improves cardiorespiratory fitness and reduces lung function decline in both cigarette and hookah smokers. It seems to be beneficial in the prevention programs of hypertension. It could have important implications in prevention and treatment programs in smokers unable or unwilling to quit.

Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients

[Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20–40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20–40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for 60 min and participated in a traditional physical therapy program, and group B (n=15), which only participated in a traditional exercise program 3 days/week. Maximal aerobic capacity, treadmill time, and Berg balance scale were measured before and after the study. [Results] In both groups, the results revealed significant improvements after treatment in all measurements; however, the improvement in group A was superior to that in group B. [Conclusion] The results provide evidence that aerobic exercises for adults with healed burn injuries improve aerobic physical fitness and balance.

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training

INTRODUCTION

Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers.

AIM

To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers.

METHODS

Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (VO2max). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program.

RESULTS

As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved VO2max (4.4 and 4.7%, respectively), v VO2max (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively).

CONCLUSIONS

After 12 weeks of interval training program, the increase of VO2max and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors.

An official European Respiratory Society statement on physical activity in COPD

This European Respiratory Society (ERS) statement provides a comprehensive overview on physical activity in patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary Task Force of experts representing the ERS Scientific Group 01.02 "Rehabilitation and Chronic Care" determined the overall scope of this statement through consensus. Focused literature reviews were conducted in key topic areas and the final content of this Statement was agreed upon by all members. The current knowledge regarding physical activity in COPD is presented, including the definition of physical activity, the consequences of physical inactivity on lung function decline and COPD incidence, physical activity assessment, prevalence of physical inactivity in COPD, clinical correlates of physical activity, effects of physical inactivity on hospitalisations and mortality, and treatment strategies to improve physical activity in patients with COPD. This Task Force identified multiple major areas of research that need to be addressed further in the coming years. These include, but are not limited to, the disease-modifying potential of increased physical activity, and to further understand how improvements in exercise capacity, dyspnoea and self-efficacy following interventions may translate into increased physical activity. The Task Force recommends that this ERS statement should be reviewed periodically (e.g. every 5-8 years).

The influence of active and passive smoking on the cardiorespiratory fitness of adults

BACKGROUND

The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test.

METHODS

The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol.

RESULTS

VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = - 0.401, p = 0.044), percentage of body fat (r = - 0.429, p = 0.011), and waist circumference (WC) (r = - 0.382, p = 0.025).

CONCLUSION

VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.

Validity and reliability of the Self-Reported Physical Fitness (SRFit) survey

BACKGROUND

An accurate physical fitness survey could be useful in research and clinical care.

PURPOSE

To estimate the validity and reliability of a Self-Reported Fitness (SRFit) survey; an instrument that estimates muscular fitness, flexibility, cardiovascular endurance, BMI, and body composition (BC) in adults ≥ 40 years of age.

METHODS

201 participants completed the SF-36 Physical Function Subscale, International Physical Activity Questionnaire (IPAQ), Older Adults' Desire for Physical Competence Scale (Rejeski), the SRFit survey, and the Rikli and Jones Senior Fitness Test. BC, height and weight were measured. SRFit survey items described BC, BMI, and Senior Fitness Test movements. Correlations between the Senior Fitness Test and the SRFit survey assessed concurrent validity. Cronbach's Alpha measured internal consistency within each SRFit domain. SRFit domain scores were compared with SF-36, IPAQ, and Rejeski survey scores to assess construct validity. Intraclass correlations evaluated test-retest reliability.

RESULTS

Correlations between SRFit and the Senior Fitness Test domains ranged from 0.35 to 0.79. Cronbach's Alpha scores were .75 to .85. Correlations between SRFit and other survey scores were -0.23 to 0.72 and in the expected direction. Intraclass correlation coefficients were 0.79 to 0.93. All P-values were 0.001.

CONCLUSION

Initial evaluation supports the SRFit survey's validity and reliability.

Self-reported physical activity and lung function two months after cardiac surgery--a prospective cohort study

BACKGROUND

Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

METHODS

Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

RESULTS

The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 ± 11% of preoperative value vs. 91 ± 9%; p = 0.03), inspiratory capacity (94 ± 14% vs. 88 ± 19%; p = 0.008), and total lung capacity (96 ± 11% vs. 90 ± 11%; p = 0.01).

CONCLUSIONS

An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

A higher tidal volume may be used for athletes according to measured FVC

We investigated whether professional athletes may require higher tidal volume (Tv ) during mechanical ventilation hypothesizing that they have significantly higher "normal" lung volumes compared to what was predicted and to nonathletes. Measured and predicted spirometric values were recorded in both athletes and nonathletes using a Spirovit SP-1 spirometer (Schiller, Switzerland). Normal Tv (6 mL/kg of predicted body weight) was calculated as a percentage of measured and predicted forced vital capacity (FVC) and the difference (δ) was used to calculate the additional Tv required using the equation: New Tv(TvN) = Tv + (Tv × δ). Professional athletes had significantly higher FVC compared to what was predicted (by 9% in females and 10% in males) and to nonathletes. They may also require a Tv of 6.6 mL/kg for males and 6.5 mL/kg for females during mechanical ventilation. Nonathletes may require a T v of 5.8 ± 0.1 mL/kg and 6.3 ± 0.1 mL/kg for males and females, respectively. Our findings show that athletes may require additional Tv of 10% (0.6/6 mL/kg) for males and 8.3% (0.5/6 mL/kg) for females during general anesthesia and critical care which needs to be further investigated and tested.

Respiratory function and changes in lung epithelium biomarkers after a short-training intervention in chlorinated vs. ozone indoor pools

Background

Swimming in indoor pools treated with combined chemical treatments (e.g. ozone) may reduce direct exposure to disinfection byproducts and thus have less negative effects on respiratory function compared to chlorinated pools. The aim of this study is to analyze the effects of a short-term training intervention on respiratory function and lung epithelial damage in adults exercising in indoor swimming pool waters treated with different disinfection methods (chlorine vs. ozone with bromine).

Methods

Lung permeability biomakers [surfactant protein D (SP-D) and Clara cell secretory protein (CC16) in plasma] and forced expiratory volumes and flow (FEV1, FVC and FEF_25–75) were measured in 39 healthy adults. Thirteen participants swam during 20 sessions in a chlorinated pool (CP), 13 performed and equivolumic intervention in an ozone pool (OP) and 13 were included in a control group (CG) without exposition.

Results

Median plasma CC16 levels increased in CP swimmers (4.27±3.29 and 6.62±5.51 µg/L, p = 0.01, pre and post intervention respectively) while no significant changes in OP and CG participants were found. No significant changes in median plasma SP-D levels were found in any of the groups after the training period. FVC increased in OP (4.26±0.86 and 4.43±0.92 L, p<0.01) and CP swimmers (4.25±0.86 and 4.35±0.85 L, p<0.01). FEV1 only increased in OP swimmers (3.50±0.65 and 3.59±0.67, p = 0.02) and FEF_25–75 decreased in CP swimmers (3.70±0.87 and 3.37±0.67, p = 0.02).

Conclusion

Despite lung function being similar in both groups, a higher lung permeability in CP compared to OP swimmers was found after a short-term swimming program. Combined chemical treatments for swimming pools such as ozone seem to have less impact on lung epithelial of swimmers compared to chlorinated treated pools.

Physical Activity and Lung Function Growth in a Cohort of Chinese School Children: A Prospective Study

BACKGROUNDS/OBJECTIVES

Evidence on the association between physical activity and lung function in children is sparse. The aim of this study was to evaluate children's lung function growth in relation to their physical activity level in Chinese children.

METHODS

A total of 1713 school children aged 9.89±0.86 years who were asthma-free at baseline were followed-up for 18 months from 2006 to 2008 in Guangzhou, China. Information on physical activity and other socio-economic status were obtained from self-administered questionnaires. Lung function tests were performed with a standard procedure.

RESULTS

At the baseline survey, physically active girls had significantly higher forced vital capacity (FVC) than inactive girls (1.79 l vs. 1.75 l, p<0.05). The growth rates for lung function indices were significantly higher for girls who were physically active at either or both follow-up surveys than those inactive at both surveys during the follow-up period forced expiratory flows at 25% (FEF25) difference per year (dpy) (0.20 l/s vs. 0.15 l/s), forced expiratory flows at 75% (FEF75) dpy (0.57 l/s vs. 0.45 l/s) and forced expiratory flows between 25% and 75% (FEF25-75) dpy (0.36 l/s vs. 0.28 l/s) (all p<0.05).

CONCLUSIONS

Physical activity is positively associated with lung function growth among Chinese school-aged girls. Promotion of physical activity among children is of great importance.

Relationship between ventilatory function and age in master athletes and a sedentary reference population

Ageing is accompanied with a decline in respiratory function. It is hypothesised that this may be attenuated by high physical activity levels. We performed spirometry in master athletes (71 women; 84 men; 35-86 years) and sedentary people (39 women; 45 men; 24-82 years), and calculated the predicted lung age (PLA). The negative associations of age with forced expiratory volume in 1 s (FEV1; 34 mL·year(-1)) and other ventilatory parameters were similar in controls and master athletes. FEV1pred was 9 % higher (P < 0.005) and PLA 15 % lower (P = 0.013) in athletes than controls. There were no significant differences between endurance and power athletes and sedentary people in maximal inspiratory and expiratory pressure. Neither age-graded performance nor weekly training hours were significantly related to lung age. Life-long exercise does not appear to attenuate the age-related decrease in ventilatory function. The better respiratory function in master athletes than age-matched sedentary people might be due to self-selection and attrition bias.

Single and concurrent effects of endurance and resistance training on pulmonary function

OBJECTIVE(S)

As not only few evidences but also contradictory results exist with regard to the effects of resistance training (RT) and resistance plus endurance training (ERT) on respiratory system, so the purpose of this research was therefore to study single and concurrent effects of endurance and resistance training on pulmonary function.

MATERIALS AND METHODS

Thirty seven volunteer healthy inactive women were randomly divided into 4 groups: without training as control (C), Endurance Training (ET), RT, and ERT. A spirometry test was taken 24 hrs before and after the training course. The training period (8 weeks, 3 sessions/week) for ET was 20-26 min/session running with 60-80% maximum heart rate (HR max); for RT two circuits/session, 40-60s for each exercise with 60-80% one repetition maximum (1RM), and 1 and 3 minutes active rest between exercises and circuits respectively; and for ERT was in agreement with either ET or RT protocols, but the times of running and circuits were half of ET and RT.

RESULTS

ANCOVA showed that ET and ERT increased significantly (P< 0.05) vital capacity (VC), forced vital capacity (FVC), and forced expiratory flows to 25%-75%; ET, RT and ERT increased significantly (P< 0.05) maximum voluntary ventilation (MVV); and only ET increased significantly (P<0.05) peak expiratory flows (PEF); but ET, RT and ERT had no significant effect (P>0.05) on forced expiratory volume in one second (FEV1) and FEV1/FVC ratio.

CONCLUSION

In conclusion, ET combined with RT (ERT) has greater effect on VC, FVC, FEF rating at25%-75%, and also on PEF except MVV, rather than RT, and just ET has greater effect rather than ERT.

The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness

AIMS

Current knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardiorespiratory fitness. We aimed to test the following hypotheses: (i) metabolically healthy but obese individuals have a higher fitness level than their metabolically abnormal and obese peers; (ii) after accounting for fitness, metabolically healthy but obese phenotype is a benign condition, in terms of cardiovascular disease and mortality.

METHODS AND RESULTS

Fitness was assessed by a maximal exercise test on a treadmill and body fat per cent (BF%) by hydrostatic weighing or skinfolds (obesity = BF% ≥ 25 or ≥ 30%, men or women, respectively) in 43 265 adults (24.3% women). Metabolically healthy was considered if meeting 0 or 1 of the criteria for metabolic syndrome. Metabolically healthy but obese participants (46% of the obese subsample) had a better fitness than metabolically abnormal obese participants (P < 0.001). When adjusting for fitness and other confounders, metabolically healthy but obese individuals had lower risk (30-50%, estimated by hazard ratios) of all-cause mortality, non-fatal and fatal cardiovascular disease, and cancer mortality than their metabolically unhealthy obese peers; while no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants.

CONCLUSIONS

(i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.

Breathlessness and skeletal muscle weakness in patients undergoing lung health screening in primary care

Earlier diagnosis of COPD is a major public health challenge as symptoms may be attributed to the normal consequences of aging. The optimum strategy for identifying patients with COPD remains to be determined. People aged 35 and over (n = 1896) on a GP practice register were randomised to either invitation or an opportunistic lung health check which included spirometry, quadriceps strength and MRC dyspnoea score. Then, 101 participants subsequently completed the General Practice Physical Activity Questionnaire. A total of 335 attended over a 15-week period; 156 were in the invitation group and 179 from the opportunist group. In 25 persons, spirometry was unsatisfactory or contraindicated. Spirometry was normal in 204(65.8%) and restrictive in 36(11.6%). 70(22.6%) had airflow obstruction, corresponding to Global Initiative for Chronic Lung Disease (GOLD) stages I-IV in 18(5.8%), 35(11.3%), 14(4.5%) and 3(1.0%), respectively. The opportunist group were significantly more likely to have airflow obstruction 30.1% vs 14.3% (p = 0.001). Breathlessness was reported commonly (40.5%) and quadriceps strength correlated significantly with MRC dyspnoea score independent of age, sex, pack-years smoked, fat-free mass and FEV(1) percent predicted. This relationship was also present in the subgroup of healthy participants (n = 143). 51.5% of participants screened were classified as "inactive" and this group were weaker and more breathless than those who were more active. Airflow obstruction was more common in those screened opportunistically. Breathlessness and inactivity are common in patients taking part in spirometry screening. Breathlessness is significantly associated with leg strength independent of spirometry and should be amenable to interventions to increase physical activity.

Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery--a randomized controlled trial

BACKGROUND

This study aimed to determine whether morbidly obese women have an alteration of heart rate (HR) kinetics and HR variability (HRV) during the 6-min walk test (6MWT) and if an aerobic exercise training can modify these indexes after gastric bypass surgery (GBS).

DESIGN AND METHODS

Nineteen morbidly obese women were randomized to a trained (TG) or control group and 12 women of eutrophic group (EG) were also evaluated. The obese women were tested on two occasions: 1 week before and 4 months after GBS through record of HR and R-R intervals during 6MWT for analysis HR kinetics. The TG underwent an aerobic exercise training program on a treadmill (1-h session, totaling 36 sessions over 12-week).

RESULTS

Both obese groups demonstrated a significant reduction of rMSSD and slower HR kinetics during the 6MWT when compared to the EG. In addition, only the TG demonstrated a significant improvement in HRV indexes, walking distance, faster time constant and mean response time of HR during 6MWT after training (p < 0.05).

CONCLUSION

Morbidly obese women have slower HR kinetics and altered cardiac modulation during submaximal exercise. However, aerobic exercise training can produce beneficial adaptations in HRV and faster HR kinetics following GBS.

The changing field of rehabilitation: optimizing spontaneous regeneration and functional recovery

For neurorehabilitation of patients with spinal cord injury (SCI), the traditional emphasis on social adaptation is being expanded to include strategies that promote plasticity and regeneration in the central nervous system. Such strategies are needed to optimize recovery of neurological function. For example, the known dependence of most cellular processes on physical activity has led to the novel concept that activity is important in neural repair. This hypothesis has given rise to activity-based restoration therapies (ABRT), which aim to optimize neural activity in the damaged spinal cord, particularly below the injury level. Here, we review the basic science and clinical evidence supporting the lifelong use of ABRT for recovery from spinal cord injury. We define and describe ABRT, and discuss its components, its clinical applications, its relationship to medical management of spinal cord injury, and the potential influences of medications on recovery. We also discuss the health benefits of ABRT under physiological and pathological conditions. We stress that lifelong ABRT is required to optimize return of function and to allow patients to benefit from any "cures" that will be discovered.

Effects of upper body resistance training on pulmonary functions in sedentary male smokers

Background:

Cigarette smoking is well correlated with lung diseases such as chronic obstructive pulmonary disease. It is common among men than women in India. In addition, sedentary lifestyle is associated with less efficient pulmonary function. Effectiveness of upper body resistance training (UBRT) in improving pulmonary function is unclear. Keeping all these factors in view, this study aims to examine the effect of UBRT on pulmonary function in male sedentary smokers.

Materials and Methods:

This study recruited 36 sedentary male smokers, of which 30 were randomized into two groups after fulfilling eligibility criteria-an exercising experimental group (EG) (N=15) or non-exercising control group (CG) (N=15). The EG group were assigned to exercise for 4 weeks, 3 times weekly on non-consecutive days using UBRT program and breathing exercise. In the CG, only breathing exercise was given for 10 min. Both groups were equivalent in baseline characteristics.

Results:

The improvement in forced expiratory volume in one second (FEV₁) and FEV₁/forced vital capacity (FVC) values were seen significant in EG after 4 weeks of UBRT: from 3.62±0.56 to 3.96±0.51 (P=0.000) and 0.88±0.11 to 0.96±0.13 (P<0.001), respectively. But FVC did not show significant change in the EG (P=0.430). There were no significant changes in FEV₁, FVC, and FEV₁/FVC values in CG after 4 weeks of intervention. On intergroup comparison, significant difference was found between CG and EG for FEV₁ and FEV₁/FVC values.

Conclusion:

Four weeks of UBRT program brought about significant changes in the pulmonary function in male sedentary smokers.

In fitness and health? A prospective study of changes in marital status and fitness in men and women

The authors examined the prospective associations between marital status transitions and changes in fitness in men and women. Between 1987 and 2005, a total of 8,871 adults (6,900 men) aged 45.6 (standard deviation, 9.1) years were examined at the Cooper Clinic, Dallas, Texas; the median follow-up was ∼3 years. Marital transition categories (from single to married, married to divorced, divorced to remarried) were derived from self-reported marital status at baseline and follow-up. Fitness (maximal oxygen consumption) was assessed by a maximal treadmill test. Analyses were adjusted for baseline levels and changes in body mass index, physical activity, smoking, alcohol consumption, and major chronic diseases. Compared with the corresponding "control" groups (remaining single, married, or divorced), transitioning from being single to married was associated with a reduction in fitness in women (P = 0.03); divorce was associated with an increase in fitness in men (P = 0.04); and remarriage was associated with a reduction in fitness in men (P = 0.05). The authors conclude that the transitions to being married (from single to married or from divorced to remarried) are associated with a modest reduction, while divorce is associated with a modest increase in fitness levels in men. Study results suggest that these patterns may be different in women, but further research is required to confirm this.

Associations between Physical Activity and Submaximal Cardiorespiratory and Pulmonary Responses in Men

BACKGROUND: Habitual physical activity (PA) is associated with higher cardiorespiratory fitness values, but additional information is needed on the contributions of specific types and amounts of PA. Therefore the main aim of this study was to analyze the heart and lung function of a large cohort of men and compare these outcomes with various modes and volumes of PA. METHODS: We used data from 30,594 men from the Aerobics Center Longitudinal Study who were categorized into sedentary, swimmer, walker, and runner groups using self-report PA data collected during 1970-2005. Additional PA categories using MET-minutes/week were used to group men into 5 distinct levels of activity (0 MET-min, 1-499 MET-min, 500-999 MET-min, 1000-1499 MET-min, and ≥ 1500 MET-min). Each participant also completed a maximal treadmill exercise test to quantify their fitness level. Cross-sectional analyses included general linear modeling and multiple comparisons adjusted for age, smoking status, and histories of myocardial infarction, stroke, diabetes, and hypertension. RESULTS: A dose-response linear effect was found for heart function variables across PA MET-min categories. Stronger associations for resting heart rate (HR), heart rate recovery (HRR), exercise HR, and exercise blood pressure were found with the runner and swimming groups when compared to the walkers and sedentary groups. Walkers had significantly better heart function than the sedentary group but only about half the effect seen in the swimmers and runners. Lung function findings showed greater absolute values in FVC and FEV1 across PA categories, but found no difference in lung function ratios (e.g FEV1/FVC%). CONCLUSIONS: We found beneficial linear associations with resting HR, exercise HR, HRR, fitness values, FVC, and FEV1 over increasing MET-min categories. This implies that habitual PA, such as walking, but especially swimming and running, when performed with adequate volume, are viable ways to gain benefits for heart health.

Psychological well-being, cardiorespiratory fitness, and long-term survival

BACKGROUND

Psychological well-being is associated with mortality/survival. Although cardiorespiratory fitness (CRF) is one of the strongest predictors of mortality, studies examining the relationship between well-being and survival seldom account for the possible effects of CRF.

PURPOSE

This study examined the independent associations of psychological well-being components (low level of negative emotion and high level of positive emotion) and CRF, as well as their combined effects, with survival.

METHODS

Participants (N=4888) were examined in 1988-1997 and followed up for a median period of ∼15 years (212 deaths, 4.3%). CRF was assessed by a maximal exercise test on a treadmill. Low-level negative emotion was defined as the minimum score of the negative emotion subscale of the CES-D scale and high-level positive emotion as the maximum score of the positive emotion subscale. Results are presented as hazard ratios (95% CIs). Data were analyzed in 2009.

RESULTS

After adjustment for a set of established risk factors, men and women with low levels of negative emotion had lower risk of death than those with higher levels of negative emotion, 0.66 (95% CI=0.50, 0.87). The association persisted after additional adjustment for CRF and positive emotion. High level of positive emotion was not associated with survival. A high level of CRF independently predicted lower risk of death, 0.54 (95% CI=0.37, 0.79), compared to a low level of CRF. The risk of death in participants with both a low level of negative emotion and a high level of CRF was 0.37 (95% CI=0.22, 0.63), compared to their peers with higher levels of negative emotion/low levels of CRF.

CONCLUSIONS

Low levels of negative emotion and high levels of CRF are independent predictors of long-term survival in men and women. A strong combined effect was observed, as individuals with both a low level of negative emotion and a high level of CRF had a 63% lower risk of premature death than those with higher levels of negative emotion and a low level of CRF.

Forced expiratory volume predicts all-cause and cancer mortality in Mumbai, India: results from a population-based cohort study

BACKGROUND

Reduction in pulmonary function, as estimated by forced expiratory volume in 1 s (FEV(1)), has been found to predict all-cause mortality in developed-country populations. This study was designed to examine the association between FEV(1) and mortality in an urban developing-country population.

METHODS

Data from the large, well-characterized Mumbai Cohort Study (Maharashtra, India) were used to compute hazard ratios (HRs; deaths/100-ml FEV(1)) and 95% confidence intervals (CIs) from Cox proportional hazards regression models in which age, tobacco use, education, height and relative body weight were controlled.

RESULTS

A total of 13,261 deaths occurred in this cohort of 148,173 individuals. After controlling for important covariates, there was a 1.7% reduction in risk of overall death in women for each 100-ml increment in FEV(1) (HR = 0.983; 95% CI = 0.980-0.986) and a 1.5% reduction in men (HR = 0.985; 95% CI = 0.984-0.986). There was a 1.6% reduction in cancer deaths in women (HR = 0.984; 95% CI = 0.973-0.996) and a 0.8% reduction in men (HR = 0.992; 95% CI = 0.987-0.997). The largest reductions in women were observed in tuberculosis deaths (3.7%/100-ml increment in FEV(1)), and in men in respiratory system deaths (3.2%).

CONCLUSIONS

In a densely populated urban Indian population, FEV(1) predicted overall and cancer mortality. Effects were larger in women and were not attenuated by exclusion of smokers or restricting analyses to subjects dying >2 years from recruitment. Because FEV(1) may be affected by air pollution, which is worsening in urban areas of most developing countries, further research is recommended to deepen understanding of these factors in relation to mortality.

Effects of Tai Chi rehabilitation on heart rate responses in patients with coronary artery disease

The objective of the present study was to evaluate the effect of a six-month Tai Chi (TC) exercise cardiac rehabilitation program on two prognostic factors of cardiac events, rate-pressure product and rate-pressure product reserve, in patients with coronary artery disease (CAD). Patients (N = 54) with CAD were recruited from the clinics of cardiology and cardiovascular surgery at a regional hospital in Taiwan. Twenty-two of them enrolled in the TC rehabilitation program which consisted of weekly 90-min sessions of Yang's style TC for six months in addition to receiving usual care. The remaining 32 patients received usual care only. Modified Bruce treadmill exercise test was performed to evaluate their exercise test responses at baseline and at six months. The change over time was significantly different between the TC and control group in peak rate-pressure product (RPP) (interaction between group and time, p = 0.029) and in RPP reserve (interaction between group and time p = 0.009) over the six-month period, there was a decrease in peak RPP of 32.0 mmHg x bpm x 10(-2) and in RPP reserve of 37.4 mmHg x bpm x 10(-2) in the TC group. In conclusion, participating in a six-month TC exercise-based cardiac rehabilitation program was associated with improved peak RPP and RPP reserve during exercise testing in patients with CAD. TC exercise program may lead to a better prognosis for cardiac events in patients with CAD.

Influence of cardiorespiratory fitness on lung cancer mortality

PURPOSE

Previous studies have suggested that higher levels of physical activity may lower lung cancer risk; however, few prospective studies have evaluated lung cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of recent physical activity habits.

METHODS

Thirty-eight thousand men, aged 20-84 yr, without history of cancer, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1974 and 2002. CRF was quantified as maximal treadmill exercise test duration and was grouped for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%).

RESULTS

A total of 232 lung cancer deaths occurred during follow-up (mean = 17 yr). After adjustment for age, examination year, body mass index, smoking, drinking, physical activity, and family history of cancer, hazard ratios (95% confidence intervals) for lung cancer deaths across low, moderate, and high CRF categories were 1.0, 0.48 (0.35-0.67), and 0.43 (0.28-0.65), respectively. There was an inverse association between CRF and lung cancer mortality in former (P for trend = 0.005) and current smokers (P for trend < 0.001) but not in never smokers (trend P = 0.14). Joint analysis of smoking and fitness status revealed a significant 12-fold higher risk of death in current smokers (hazard ratio = 11.9, 95% confidence interval = 6.0-23.6) with low CRF as compared with never smokers who had high CRF.

CONCLUSIONS

Although the potential for some residual confounding by smoking could not be eliminated, these data suggest that CRF is inversely associated with lung cancer mortality in men. Continued study of CRF in relation to lung cancer, particularly among smokers, may further our understanding of disease etiology and reveal additional strategies for reducing its burden.

Aerobic capacity as an indicator in different kinds of sports

Physical capacity of athletes is an important element of success in sports achievements. Aerobic capacity has been accepted as its major component. Maximal oxygen uptake (VO2max) has been regarded by majority of authors as the best indicator of aerobic capacity of an organism, and at the same time, the best indicator of an athlete's physical capacity. The aim of the investigation was to analyze the aerobic capacity as an indicator of physical capacity of athletes, differences in their aerobic capacity with regard to the kind of sport they are practicing, as well as the differences obtained when compared to physically inactive subjects. The investigation included the determination of absolute and relative VO2max in the total of 66 male examinees. The examinees were divided into two groups of active athletes (football players (n=22) and volleyball players (n=18) of different profiles, while the third group of non-athletes served as control group. Maximal oxygen uptake was determined by performing the Astrand 6 minute cycle test. Peak values of VO2 max were recorded in the group of football players (4,25+/-0,27 l/min), and they were statistically significantly higher (p<0,001) compared to other examined groups. In the group of volleyball players the oxygen uptake was 3,95+/-0,18 l/min, while statistically significantly lower values were reported in the group of non-athletes compared to the groups of athletes (p<0,01). A similar ratio of VO2 max values was also shown by the analysis of values expressed in relative units. Our results showed that peak values of VO2 max were obtained in football players, and that football as a sport requires higher degree of endurance compared to volleyball. Having considered the morphological and functional changes which are the consequence of the training process, it can be concluded that VO2 max values are statistically significantly higher in the groups of athletes compared to the group of non-athletes.

Influence of cardiorespiratory fitness on lung cancer mortality

PURPOSE

Previous studies have suggested that higher levels of physical activity may lower lung cancer risk; however, few prospective studies have evaluated lung cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of recent physical activity habits.

METHODS

Thirty-eight thousand men, aged 20-84 yr, without history of cancer, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1974 and 2002. CRF was quantified as maximal treadmill exercise test duration and was grouped for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%).

RESULTS

A total of 232 lung cancer deaths occurred during follow-up (mean = 17 yr). After adjustment for age, examination year, body mass index, smoking, drinking, physical activity, and family history of cancer, hazard ratios (95% confidence intervals) for lung cancer deaths across low, moderate, and high CRF categories were 1.0, 0.48 (0.35-0.67), and 0.43 (0.28-0.65), respectively. There was an inverse association between CRF and lung cancer mortality in former (P for trend = 0.005) and current smokers (P for trend < 0.001) but not in never smokers (trend P = 0.14). Joint analysis of smoking and fitness status revealed a significant 12-fold higher risk of death in current smokers (hazard ratio = 11.9, 95% confidence interval = 6.0-23.6) with low CRF as compared with never smokers who had high CRF.

CONCLUSIONS

Although the potential for some residual confounding by smoking could not be eliminated, these data suggest that CRF is inversely associated with lung cancer mortality in men. Continued study of CRF in relation to lung cancer, particularly among smokers, may further our understanding of disease etiology and reveal additional strategies for reducing its burden.

Does physical inactivity cause chronic obstructive pulmonary disease?

COPD (chronic obstructive pulmonary disease) is the most common pulmonary disease and is the only common cause of death in which mortality is presently rising. It is caused by the inhalation of smoke, which leads to oxidative stress and inflammation both in the lungs and systemically. Reduced physical activity is a well-recognized consequence of the condition, but we argue here that inactivity is itself an early cause of lung function decline and symptoms. This hypothesis is supported by data from population studies that link activity levels to decline in spirometric indices, both in smokers and non-smokers. In addition, smokers with low physical activity levels are more likely to be diagnosed subsequently with COPD. Physical exercise reduces oxidative stress, has an anti-inflammatory effect and reduces the frequency of upper respiratory tract infections, providing a number of mechanisms by which it could attenuate the harmful effects of smoking. There is sufficient evidence to justify population trials of lifestyle interventions aimed at improving physical activity levels and reducing lung function decline in people diagnosed with early COPD through spirometry screening.

Physical activity and lung cancer prevention

Since lung cancer is among the cancers with the highest incidence and has the highest mortality rate of cancer worldwide, the means of reducing its impact are urgently needed. Emerging evidence shows that physical activity plays an etiological role in lung cancer risk reduction. The majority of studies support the fact that total and recreational physical activity reduces lung cancer risk by 20-30% for women and 20-50% for men, and there is evidence of a dose-response effect. The biological mechanisms operating between physical activity and lung cancer are likely complex and influenced by many factors including inherited or acquired susceptibility genes, gender, smoking, and other environmental factors. Several plausible biological factors and mechanisms have been hypothesized linking physical activity to reduced lung cancer risk including: improved pulmonary function, reduced concentrations of carcinogenic agents in the lungs, enhanced immune function, reduced inflammation, enhanced DNA repair capacity, changes in growth factor levels and possible gene-physical activity interactions. Future research should target the possible subgroup effects and the biologic mechanisms that may be involved.

Developmental adaptation: where we go from here

The concept of developmental adaptation is a powerful framework that can be used for understanding the origin of population differences in phenotypic and genotypic biological traits. There is great deal of information describing how developmental responses can shape adult biological outcomes. Specifically, current research suggest that individuals developing in stressful environments such as high altitude will attain an adult enlarged residual lung volume that contribute to the successful cardiovascular adaptation of the high-altitude Andean native. Likewise, studies on the etiology of the metabolic syndrome indicate that development under poor nutritional environments elicit efficient physiological and metabolic responses for the utilization of nutrients and energy, which become disadvantageous when the adult environmental conditions provide abundant access to food and low energy expenditure. Epigenetic research in experimental animals and retrospective research in humans confirm that environmental influences during developmental period have profound consequences on the phenotypic expression of biological and behavioral traits during adulthood. Research on epigenetics is a productive direction for human biologists concerned with understanding the origins of human biological variability.